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Published on: July 3, 2013
Chronic renal failure in children
Pankaj Hari1, Ish Kumar Singla, Mukta Mantan
1Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. pankajhari@hotmail.com
Insights
The most common causes of chronic renal failure (CRF) in children were obstructive and reflux nephropathy. Many children presented late with severe disease, malnutrition, and stunted growth, often managed conservatively due to financial constraints.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Public Health
Background:
- Chronic renal failure (CRF) in children presents a significant health challenge.
- Understanding the specific etiologies and patient demographics is crucial for effective management.
Purpose of the Study:
- To identify the primary causes of chronic renal failure (CRF) in pediatric patients at a tertiary care center.
- To analyze the clinical presentation and outcomes of children with CRF.
Main Methods:
- Retrospective review of 305 children diagnosed with chronic renal failure (CRF) over a 7-year period.
- CRF defined as glomerular filtration rate (GFR) < 50 mL/1.73 m²/min for > 3 months.
- Data collected on age, GFR, blood urea, creatinine, hemoglobin, anthropometrics, etiology, and management.
Main Results:
- Obstructive uropathy (97 children) and chronic glomerulonephritis (84 children) were the leading causes of CRF.
- Patients presented with a mean age of 8 years, significantly low GFR (median 18.5 mL/min/1.73 m²), anemia, malnutrition, and stunted growth.
- Late presentation was common, with 25.3% already in end-stage renal disease.
Conclusions:
- Obstructive and reflux nephropathy are the most frequent causes of pediatric CRF.
- Late presentation, severe disease, malnutrition, and stunting are prevalent issues.
- Financial constraints significantly impacted management, leading to conservative care for many patients.
Objective:
To determine the etiology of chronic renal failure amongst children attending the Pediatric Nephrology services at a tertiary care center.
Subject:
We reviewed the records of 305 children, diagnosed to have chronic renal failure (CRF) over a 7-year period. CRF was defined as glomerular filtration rate (GFR) below 50-mL/1.73 m2/min persisting for more than 3 months.
Results:
The mean age at onset and presentation of CRF in these patients was 5.9 and 8 years respectively. Ninety-six children were below 5 years of age. Mean (SD) levels of blood urea and creatinine at presentation were 150 and 4.6 mg/dL respectively. The median GFR at presentation was 18.5 mL/min/1.73 m(2) while 25.3 patients were already in end stage renal failure indicating that these patients were referred late. The mean (SD) hemoglobin at presentation was 7.6 (2.6) g/dL. The mean height and weight SD scores were 2.9 and 2.4 respectively. Obstructive uropathy was the commonest cause of CRF present in 97 children. Other causes included chronic glomerulonephritis in 84, reflux nephropathy in 51, hereditary nephritis in 20, renal dysplasia in 15 and hemolytic uremic syndrome in 5 children. The mean (SD) duration of follow-up was 11(15) months. Peritoneal or hemodialysis was performed in 63 patients. Fifteen patients underwent a live-related renal transplantation. The rest opted out of dialysis program and were conservatively managed due to financial constraints.
Conclusions:
The commonest causes of CRF were obstructive and reflux nephropathy. A significant proportion of patients presented late; had severe CRF and were malnourished and stunted. Majority of these were managed conservatively due to lack of financial resources.
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