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Growth evaluation in children with acute renal failure of unknown etiology
A Bettinelli1, M Bacchini, G L Paterlini
1Istituto di Clinica Pediatrica, Università di Milano, Italia.
Insights
Severe acute renal failure (ARF) in children with undiagnosed chronic renal failure (CRF) presents with significant growth failure. This indicates a poor long-term prognosis, highlighting the importance of growth indexes in diagnosis.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Growth and Development
Background:
- Severe acute renal failure (ARF) in children requires careful diagnosis to differentiate from undiagnosed chronic renal failure (CRF).
- Growth indexes at hospital admission may offer diagnostic and prognostic insights in pediatric ARF cases.
Purpose of the Study:
- To evaluate the diagnostic and prognostic value of growth indexes in children with severe ARF.
- To distinguish ARF cases with and without previously undiagnosed CRF.
Main Methods:
- Retrospective study of 47 children (over 1 year old) with severe ARF treated with hemodialysis (HD).
- Analysis of height standard deviation score (HSDS) at hospital admission.
- Comparison of HSDS between children with diagnosed ARF causes and those with unknown etiology.
Main Results:
- Six children with ARF of unknown etiology had significantly lower HSDS values compared to 41 children with diagnosed ARF causes (p < 0.001).
- These 6 children exhibited symptoms of uremia for many years, suggesting pre-existing CRF.
- Causes of ARF in the diagnosed group included hemolytic uremic syndrome, renal vein thrombosis, and glomerulonephritis.
Conclusions:
- Growth failure in children with ARF of unknown etiology strongly suggests previously undiagnosed chronic renal failure (CRF).
- This finding has significant implications for long-term prognosis in pediatric patients with severe ARF.
- Height standard deviation score (HSDS) is a valuable criterion for identifying children with undiagnosed CRF requiring hemodialysis.
Abstract:
We performed a retrospective study on 47 children over 1 year of age with severe acute renal failure (ARF) treated with hemodialysis (HD) at our Center from 1978 to 1986 in order to evaluate the diagnostic and prognostic value of growth indexes at hospital admission as a criterion to distinguish cases of ARF without previous chronic renal failure (CRF) from cases in which CRF was not previously diagnosed. The age of the patients ranged from 17 months to 13 years. The cause of ARF was identified in 41 children; 5 of them remained on HD for different reasons (hemolytic uremic syndrome with arteriolar involvement in 3 cases; renal vein thrombosis in 1; endoextracapillary glomerulonephritis in 1). No apparent cause of ARF was found in the other 6 children who remained on chronic HD. A careful history showed that these 6 children had had uremic symptoms for many years. When height was expressed as height standard deviation score (HSDS), the 6 children with ARF of unknown etiology showed significantly lower HSDS values compared with the other 41 children in whom a cause of ARF was diagnosed (p less than 0.001). In conclusion, growth failure in children requiring HD for ARF of unknown etiology is an important criterion that suggests a previously undiagnosed CRF and thus consequently a negative long-term prognosis.