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Etiology and outcome of chronic renal failure in Indian children
S Gulati1, S Mittal, R K Sharma
1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226014, UP, India, sgulati@sgpgi.ac.in
Insights
Chronic renal failure (CRF) in Indian children presents late and has a poor prognosis. Limited access and high costs of renal replacement therapy contribute to poor outcomes in pediatric kidney disease.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Public Health
Background:
- Chronic renal failure (CRF) is a significant health concern in pediatric populations.
- Early diagnosis and intervention are crucial for managing pediatric kidney disease.
- Understanding the epidemiology and outcomes of CRF in specific regions like India is vital.
Purpose of the Study:
- To prospectively analyze new pediatric cases of chronic renal failure (CRF) over one year.
- To identify the causes, clinical presentation, and outcomes of CRF in Indian children.
- To evaluate the prognostic factors influencing pediatric CRF in the Indian healthcare setting.
Main Methods:
- Prospective analysis of 48 new pediatric CRF cases.
- Diagnosis based on serum creatinine >2 mg/dl with clinical, laboratory, and radiological support.
- Data collection on patient demographics, causes of CRF, duration of symptoms, comorbidities, and treatment outcomes.
Main Results:
- The median age of patients was 13 years; common causes included glomerulonephritis (37.5%) and obstruction/interstitial diseases (52%).
- Over half of the patients (54%) presented with end-stage renal disease.
- At follow-up, significant proportions were on conservative treatment (21%), dialysis (14.6%), or had received transplants (16.7%), with a mortality rate of 8.3%.
Conclusions:
- Pediatric CRF in India is characterized by late presentation and a poor prognosis.
- Late referral, limited availability, and high costs of renal replacement therapy are major contributing factors.
- Improved access to timely diagnosis and affordable renal replacement therapies are essential for better outcomes.
Abstract:
A prospective analysis of all new pediatric cases of chronic renal failure (CRF) was performed at our hospital over a 1-year period. The diagnosis of CRF was based on serum creatinine >2 mg/dl with supportive clinical, laboratory, and radiological findings. There were a total of 48 patients with CRF with a median age of 13 years (range 10 days to 16 years). The causes of CRF included glomerulonephritis (37.5%), obstruction and interstitial (52%), hereditary (6.3%), and undetermined (4.2%). Patients were symptomatic for a mean of 33.2 months (range 10 days to 11 years) at presentation. Eight patients (16.7%) had acute reversible deterioration of renal function at presentation. This was due to accelerated hypertension in 2, infection in 3, volume depletion in 2, and nonsteroidal antiinflammatory drugs in 1 patient. At presentation, 22 (46%) children had mild to moderate renal failure and 26 (54%) had end-stage renal disease. Twenty-one children (43. 7%) had associated illness at presentation. Mean follow-up was 22.9 weeks (range 2-126 weeks). At the end of the study period, 10 (21%) patients were on conservative treatment, 7 (14.6%) on maintenance dialysis, 8 (16.7%) patients had functioning allografts, 4 (8.3%) patients had died, and 19 (39.6%) opted against further therapy. We conclude that CRF in Indian children carries a poor prognosis due to late referral and the limited availability and high cost of renal replacement therapy.