Etiology, presentation and management of acute renal failure in Saudi children

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Public Health

Background:

• Acute renal failure (ARF) is a significant concern in pediatric populations.
• Understanding the causes, management, and outcomes of ARF in children is crucial for improving patient care.
• Previous studies have highlighted various etiologies and prognoses, necessitating localized data.

Purpose of the Study:

• To analyze the etiological factors, treatment modalities, and outcomes of acute renal failure in children admitted to a tertiary care center.
• To identify the most prevalent causes of ARF in the pediatric population within the study region.
• To evaluate the effectiveness of conservative management versus dialysis and determine factors influencing patient outcomes.

Main Methods:

• A retrospective analysis of 100 pediatric patients diagnosed with ARF over a four-year period.
• Data collection included patient demographics, etiological factors (pre-renal, intrinsic, post-renal), treatment interventions (conservative, peritoneal dialysis, hemodialysis), and patient outcomes.
• Statistical analysis was performed to determine the frequency of different causes and the correlation between treatment and outcomes.

Main Results:

• Male children outnumbered females (3:2 ratio), with ages ranging from 1 month to 13 years (mean 3.9 years).
• Intrinsic renal factors (55%) were the leading cause, with acute glomerulonephritis (27 cases) and hemolytic-uremic syndrome (15 cases) being most common. Posterior urethral valve (20 cases) was the primary post-renal cause, and diarrheal disease led to all pre-renal failures.
• Sixty percent of patients were cured, 29% had persistent renal failure, and 11% died, primarily from sepsis and cardiorespiratory failure. Forty patients required dialysis (23 peritoneal, 17 hemodialysis).

Conclusions:

• Intrinsic renal diseases, particularly acute glomerulonephritis and hemolytic-uremic syndrome, are the predominant causes of ARF in children in this setting.
• While a majority of children recover from ARF, a substantial proportion face long-term renal impairment or mortality, emphasizing the need for early diagnosis and intervention.
• Sepsis and cardiorespiratory failure represent critical complications leading to mortality in pediatric ARF cases, highlighting the importance of vigilant monitoring and supportive care.