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Prognosis of patients with acute renal failure without cardiopathy
N Gallego1, C Pérez-Caballero, A Gallego
1Servicio de Nefrología, Hospital Ramón y Cajal, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain. ngallego@hrc.insalud.es
Insights
Prognosis for children with acute renal failure (ARF) depends on the cause. Factors like hypotension, ventilation, dialysis, and BUN levels predict mortality risk in pediatric ARF patients.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Medicine
Background:
- Acute renal failure (ARF) in children can lead to poor outcomes.
- Limited research exists on the prognosis of pediatric ARF.
- Understanding risk factors for mortality is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors for mortality in children with acute renal failure.
- To develop a predictive score for mortality in this patient group.
Main Methods:
- Prospective study of 92 children without heart disease from 1978 to 1998.
- Analysis of mortality risk factors using univariate and multivariate methods.
- Development of a predictive score based on identified risk factors.
Main Results:
- Children with tumors, shock, or other causes had a 45% mortality rate, unlike those with primary urinary tract issues.
- Hypotension, high BUN/creatinine, mechanical ventilation, or dialysis indicated poor outcomes in the non-primary urinary tract group.
- A predictive score was developed: -0.02 + 0.28 (hypotension) + 0.19 (ventilation) + 0.27 (dialysis) + 0.01 (BUN).
Conclusions:
- Pediatric ARF mortality is linked to the underlying cause (aetiology).
- The need for dialysis and/or mechanical ventilation significantly impacts prognosis.
- Hypotension and elevated Blood Urea Nitrogen (BUN) are critical indicators of poor outcomes in pediatric ARF.
Background:
The outcome for children with acute renal failure (ARF) may be poor. However, relatively few published studies have considered prognosis of these patients.
Methods:
We prospectively studied, from 1978 to 1998, 92 such children without heart disease to try to identify risk factors for mortality.
Results:
Forty five per cent of children with tumours, shock, and other causes died compared with none of those with a primary urinary tract related problem. ARF did not seem to be the cause of death in any case. Univariate analysis showed that in the non-primary urinary problem group (55 cases), patients with hypotension, high values of BUN or creatinine, or who needed mechanical ventilation or dialysis, had a poor outcome. Multivariate analysis showed that probability of death can be estimated using the following score: -0.02 + 0.28 (hypotension) + 0.19 (ventilation) + 0.27 (dialysis) + 0.01 (BUN).
Conclusions:
Mortality of patients with ARF was related to aetiology, the need for dialysis and/or ventilator use, hypotension, and BUN values.