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Pattern of acute renal failure at a referral hospital
1Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
Insights
Acute renal failure (ARF) in children is often caused by Hemolytic Uremic Syndrome (HUS), Acute Tubular Necrosis (ATN), or glomerulonephritis. Early intervention and dialysis are crucial for improving outcomes in pediatric ARF patients.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Critical Care Pediatrics
Background:
- Acute renal failure (ARF) presents a significant challenge in pediatric populations.
- Understanding the etiological spectrum and prognostic factors is vital for effective management.
Purpose of the Study:
- To determine the causes and outcomes of acute renal failure in children.
- To identify factors influencing mortality in pediatric ARF.
Main Methods:
- Retrospective analysis of 52 children (up to 12 years) admitted with ARF between 1989 and 1992.
- Evaluation of etiological factors, clinical presentation, need for dialysis, and mortality.
Main Results:
- Hemolytic Uremic Syndrome (HUS) was the most common cause (30.8%), followed by Acute Tubular Necrosis (ATN) (28.84%).
- Anuria at presentation was noted in 53.6% of patients, with HUS being a leading cause.
- Mortality rate was 34.6%, with HUS, post-surgical ARF, ATN, glomerulonephritis, and obstructive uropathy contributing to deaths.
- Anuria, CNS/respiratory complications, and delayed dialysis were poor prognostic indicators.
Conclusions:
- HUS, ATN, and glomerulonephritis are primary causes of pediatric ARF.
- Early referral and prompt initiation of dialytic support are critical for reducing mortality in children with ARF.
Abstract:
Fifty two children (upto 12 years age) with acute renal failure (ARF) admitted to the Nephrology services between January, 1989 to August, 1992 were studied to determine the cause and outcome. Of these, 39 were boys and 13 girls; 27 (51.9%) patients were below 4 years of age. Hemolytic uremic syndrome (HUS) was the commonest cause of ARF (30.8%) followed by acute tubular necrosis (ATN) in 28.84% and acute glomerulonephritis in 19.23%. All patients had severe renal involvement with anuria in 53.6% and oliguria in 46.4% at presentation. HUS was the leading cause of anuria (53.6%), followed by obstructive uropathy (21.4%). Thirty five patients required dialytic support for a median duration of 18 days (2-90 days). The mortality was 34.6%. Seven patients of HUS, 4 patients of ARF following surgery, 3 patients each of ATN and glomerulonephritis and one patient of obstructive uropathy died. Anuria at onset, central nervous system or respiratory complications and delay in institution of dialytic support were bad prognostic factors. We conclude that early referral and prompt institution of dialytic support may be helpful in decreasing the mortality.