Acute Renal Failure in Children at Thammasat University Hospital

Abstract

Background: Acute renal failure (ARF) is a clinical syndrome in which a sudden deterioration in renal function results in the inability of the kidneys to maintain fl uid and electrolyte homeostasis. ARF is a major health problem of the children and life-threatening event. Thus, if we can diagnose and treat ARF promptly, the renal function may be restored and decrease morbidity and mortality rate of the patients.

Objectives: To review the cause, clinical manifestations, complications and outcomes of ARF in children.Methods: The case records for children 1 day to 15 years of age who were diagnosed as ARF between 2004 and 2009, in the Department of Pediatrics, Thammasat University Hospital, were reviewed.

Results: A total of 32 children were included, that was 22 boys (68.8%) and 10 girls (31.2%), 1 day to 15 years of age (mean age 4.97+ 5.28 years). Hypovolemia and hypovolemic shock were the most common causes of ARF (13 cases, 40.7%) followed by sepsis (11 cases, 34.4%), lupus nephritis (3 cases, 9.4%). Prerenal ARF was the most common type of ARF (16 cases, 50%), followed by intrinsic ARF (15 cases, 46.9%) and postrenal ARF (1 case, 3.1%). Oliguria was the most common clinical manifestation (20 cases, 62.5%) followed by dehydration (10 cases, 31.2%), hypertension (4 cases, 12.5%) and edema (4 cases, 12.5%).The complications were identifi ed in 16 cases (50.0%). Hyponatremia was the major complication of ARF(6 cases, 18.8%) followed by hypertension (5 cases, 15.6%), hyperkalemia (3 cases, 9.4%) and pulmonary edema (2 cases, 6.3%). Most of the cases (29 cases, 90.6%) were under supportive treatment. Hemodialysis was performed in 5 cases (15%) and peritoneal dialysis was perfomed in 1 case (3.1%). The treatment outcome revealed complete recovery in 18 cases (56.3%), death in 11 cases (34.4%), chronic renal failure in 2 cases (6.3%) and end-stage renal disease in 1 case (3.1%). The mortality rate was 34.4%. Sepsis was the major cause of death.

Conclusion: Prerenal ARF due to hypovolemia and hypovolemic shock was a major cause of ARF in children. Oliguria was the most common clinical manifestation. Hyponatremia was the major complication. Most of the cases were under supportive treatment. The mortality rate was high. Sepsis was the major cause of death.

Key words: Acute renal failure, Prerenal failure, Oliguria, Hypovolemia, Hyponatremia, Mortality rate, Sepsis