Ten-year follow-up of children after acute renal failure from a developing country

Area of Science:

• Pediatric Nephrology
• Renal Medicine
• Public Health in Developing Countries

Background:

• Acute renal failure (ARF) in children has well-documented acute mortality and morbidity.
• Long-term follow-up studies, especially from developing countries, are scarce.
• Understanding the long-term renal outcomes in pediatric ARF is essential for effective management.

Purpose of the Study:

• To investigate the spectrum of acute renal failure in children presenting to a tertiary care center in India.
• To conduct a 10-year follow-up study on renal survival and mortality in pediatric ARF patients.
• To identify factors associated with long-term adverse renal outcomes in childhood ARF.

Main Methods:

• A cohort of 37 children aged 1 month to 10 years with ARF was enrolled between April and September 1996.
• Children with pre-existing renal abnormalities were excluded.
• Patients were monitored for renal survival, mortality, and renal parameters for up to 10 years post-ARF.

Main Results:

• Glomerulonephritis and snakebite were the most common causes of ARF.
• Acute mortality was 35%, significantly associated with peak creatinine and multiple organ failure.
• At 10 years, 38% of survivors exhibited at least one abnormal renal parameter (abnormal creatinine, hypertension, hematuria, proteinuria).
• Snakebite, high acute-stage peak creatinine, and prolonged oliguria were linked to poor long-term outcomes.

Conclusions:

• A significant proportion of children surviving acute renal failure experience long-term renal morbidity.
• Approximately 25% of survivors showed renal morbidity 10 years after the initial ARF episode.
• These findings underscore the necessity for long-term follow-up in pediatric ARF survivors.