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Acute renal failure in children requiring dialysis therapy
P W Kandoth1, G J Agarwal, V R Dharnidharka
1Department of Pediatrics, T.N. Medical College, Bombay.
Insights
This study on pediatric acute renal failure found high mortality despite dialysis. Delayed medical attention and factors like female sex and young age were associated with poorer outcomes in children requiring dialysis.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Acute renal failure (ARF) in children presents significant challenges.
- Understanding etiological factors and outcomes is crucial for improving pediatric ARF management.
Purpose of the Study:
- To analyze the causes, clinical features, treatment, and outcomes of acute renal failure in children requiring dialysis.
- To identify factors influencing prognosis and mortality in this pediatric population.
Main Methods:
- A prospective study of 48 children with ARF requiring dialysis over two and a half years.
- Data collected on demographics, etiology, clinical presentation, dialysis modality, and patient outcomes.
- Follow-up assessments for survivors to evaluate renal function recovery.
Main Results:
- Renal causes predominated (65%), with acute glomerulonephritis, hypovolemia, tubular necrosis, and hemolytic uremic syndrome being common. Delayed medical attention was noted in 48% of cases.
- Peritoneal dialysis was the primary modality (95%). Survivors showed improved renal function within a mean of 5.9 days.
- Mortality rate was high at 41.5%. Factors like female sex, age < 1 year, neurological issues, and hypotension were linked to poorer prognosis.
Conclusions:
- Pediatric acute renal failure remains a serious condition with high mortality, even with dialysis therapy.
- Early medical intervention is critical, as delays in seeking care are common and associated with adverse outcomes.
- While renal function can recover, ongoing research into etiological trends and improved management strategies is necessary to reduce mortality.
Abstract:
A prospective study over two and a half years analysed 48 children of acute renal failure requiring dialysis therapy. The mean age was 3 years 9 months and M:F ratio was 1.8:1. Renal causes predominated, accounting for 65%, with prerenal and postrenal causes responsible for 19% and 16%. Acute glomerulonephritis was seen in 13 cases, hypovolemia secondary to gastroenteritis in 9, tubular necrosis in 6, and hemolytic uremic syndrome in 5. A delay in seeking medical attention was present in as many as 48%, and was especially common with female children. All had oligo-anuria, with fluid overload present in 18.7%, hypertension in 23%, hypotension in 16.6%, neuropsychiatric manifestations in 20%, and infections in 47%. Peritoneal dialysis was carried out in 95%, and hemodialysis in 6.2%. Urine output and renal function returned to normal within 1.5 to 16 days (mean 5.9) in the survivors. Of the 28 who survived, 19 were followed up regularly for a mean of 4.25 months and all except one had normal renal function. Factors associated with a poor prognosis included female sex, age < 1 year, neurological manifestations, and hypotension, though these were not statistically significant. Mortality in our series was 41.5%. While etiological factors have shown changing trends, mortality still remains high inspite of dialysis.
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