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[Diagnosis of acute renal failure in pediatric nephrology]
Insights
Acute renal insufficiency (ARI) in children is often caused by kidney-specific issues, with renal-type ARI being most common and severe. Understanding these causes is crucial for effective pediatric nephrology care.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Critical Care Pediatrics
Background:
- Acute renal insufficiency (ARI) is a significant complication in children with various nephrological diseases.
- Understanding the etiological factors and clinical presentations of ARI in pediatric populations is essential for timely intervention.
Purpose of the Study:
- To analyze the incidence, causes, and clinical characteristics of acute renal insufficiency in hospitalized children with nephrological diseases.
- To differentiate the clinical course and severity of renal, prerenal, and postrenal types of ARI in children.
Main Methods:
- Retrospective analysis of 1695 children hospitalized with nephrological diseases over a decade.
- Classification of ARI into renal, prerenal, and postrenal causes.
- Identification of specific etiologies within renal ARI, including glomerulonephritis, acute tubular necrosis, and interstitial nephritis.
Main Results:
- ARI complicated the course of nephrological diseases in 136 children (8.0%).
- Renal ARI (69.1%) was the predominant type, followed by prerenal (23.5%) and postrenal (7.4%).
- Key causes of renal ARI included glomerulonephritis (47%), acute tubular necrosis (19%), and interstitial nephritis (14%).
- Renal ARI presented with more severe endogenous intoxication and renal function decompensation compared to prerenal ARI.
Conclusions:
- Acute renal insufficiency is a frequent and serious complication in pediatric nephrology patients.
- Renal-type ARI, often stemming from glomerulonephritis or acute tubular necrosis, carries the most severe prognosis.
- Distinguishing ARI types is critical, as renal ARI necessitates specific management strategies to mitigate severe outcomes.
Abstract:
Acute renal insufficiency (ARI) complicated the course of the underlying process, including primary and secondary glomerulonephritis, interstitial nephritis, pyelonephritis, dysmetabolic nephropathies, urolithiasis, tubulopathies, renal congenitae defects and injuries in 136 of 1695 children with nephrological diseases hospitalized at Republican Pediatric Renal Center during the last decade. In 69.1% cases ARI developed by the renal type, in 23.5% cases was caused by prerenal factors, and rarely (in 7.4% cases) by postrenal factors. Renal ARI in children was caused by 5 causes, including glomerulonephritis (47%), acute tubular necrosis (19%), interstitial nephritis (14%), vascular disorders (11%) resultant from vasculitis, renal vein thrombosis, and acute crystalluria (9%) which developed in the presence of grave dysmetabolic nephropathy. Among three clinical variants of ARI the most severe was observed in renal ARI leading to grave endogenous intoxication and pronounced decompensation of renal function. More benign course of renal ARI caused by acute tubular necrosis or acute crystalluria differed significantly from prerenal ARI by a more pronounced endogenous intoxication, increased fractionated sodium excretion, and renal insufficiency index higher than 1.