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Acute renal failure in infants in the tropics
B J Pereira1, A Narang, S Pereira
1Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Acute renal failure in tropical infants is primarily caused by septicemia and gastroenteritis, often requiring peritoneal dialysis. Mortality remains high, highlighting unique regional etiological differences.
Area of Science:
- Pediatric Nephrology
- Tropical Medicine
- Critical Care
Background:
- Acute renal failure (ARF) in infants presents unique challenges, particularly in tropical regions.
- Understanding the specific etiologies and outcomes in these environments is crucial for effective management.
Purpose of the Study:
- To document the experience with ARF in 40 infants in a tropical setting.
- To identify the leading causes, indications for dialysis, and outcomes of ARF in this population.
Main Methods:
- Retrospective analysis of 40 infants with ARF requiring intermittent peritoneal dialysis over two years.
- Review of clinical data, laboratory findings, and procedural outcomes.
Main Results:
- Septicemia (88%) and acute gastroenteritis (55%) were the primary causes of ARF.
- Indications for dialysis included elevated serum creatinine (85%), metabolic encephalopathy (75%), and acidosis (75%).
- Mortality was high at 75%, with distinct etiological patterns compared to Western data.
Conclusions:
- Intermittent peritoneal dialysis is an effective treatment for ARF in infants in the tropics.
- The etiology of ARF in this population differs significantly from Western countries, emphasizing the need for region-specific approaches.
Abstract:
This study records our experience with 40 infants who developed acute renal failure in a tropical environment over a period of 2 years. All the patients required intermittent peritoneal dialysis. Septicaemia (88%) and acute gastroenteritis (55%) constituted the leading causes of acute renal failure. Haemolytic uraemic syndrome was present in six (18%) patients. An elevated serum creatinine (85%), metabolic encephalopathy (75%), uncompensated metabolic acidosis (75%) and hyperkalaemia (48%) were the major indications for dialysis, while fluid overload was present in only 18% of the infants. Intermittent peritoneal dialysis was used in all the patients and was found to be effective. Procedural complications were minor and infrequently encountered. The clinical course and laboratory data consistent with haemolytic uraemic syndrome was observed in six patients, and acute tubular necrosis was the predominant renal lesion in the remainder. Mortality was 75%. The aetiology of acute renal failure in infants in the tropics differs significantly from that in the West, and even within a given country marked regional variations exist.