Patchy form Patches of necrosis may occupy two thirds of the cortex. Gross form Almost the entire cortex is involved. Thrombosis of the arteries is more widespread. Confluent form Kidneys show widespread glomerular and tubular necrosis with no arterial involvement. The cornerstones of therapy are to restore hemodynamic stability, institute early dialytic therapy, and treat the underlying cause.
Most cases initially require intensive care.
Early institution of dialysis treatment for renal failure is crucial for patients who are oliguric. Refer to relevant chapters for medical management of acute renal failure, including Hyperkalemia , fluid overload, and Acidosis Metabolic . Consult a pediatric nephrologist to manage acute renal failure and for ongoing chronic renal replacement therapy. Ensure adequate energy intake. Activity should continue as tolerated.