Etiology and outcome of chronic renal failure in Indian children.
A prospective analysis of all new pediatric cases of chronic renal failure (CRF) was performed at our hospital over a 1-year period. The diagnosis of CRF was based on serum creatinine >2 mg/dl with supportive clinical, laboratory, and radiological findings. There were a total of 48 patients with CRF with a median age of 13 years (range 10 days to 16 years). The causes of CRF included glomerulonephritis (37.5%), obstruction and interstitial (52%), hereditary (6.3%), and undetermined (4.2%). Patients were symptomatic for a mean of 33.2 months (range 10 days to 11 years) at presentation. Eight patients (16.7%) had acute reversible deterioration of renal function at presentation. This was due to accelerated hypertension in 2, infection in 3, volume depletion in 2, and nonsteroidal antiinflammatory drugs in 1 patient. At presentation, 22 (46%) children had mild to moderate renal failure and 26 (54%) had end-stage renal disease. Twenty-one children (43. 7%) had associated illness at presentation. Mean follow-up was 22.9 weeks (range 2-126 weeks). At the end of the study period, 10 (21%) patients were on conservative treatment, 7 (14.6%) on maintenance dialysis, 8 (16.7%) patients had functioning allografts, 4 (8.3%) patients had died, and 19 (39.6%) opted against further therapy. We conclude that CRF in Indian children carries a poor prognosis due to late referral and the limited availability and high cost of renal replacement therapy.
Gulati
S
S
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226014, UP, India, sgulati@sgpgi.ac.in
Mittal
S
S
Sharma
R K
RK
Gupta
A
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005921:Glomerulonephritis / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D007194:India; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D009026:Mortality; D009395:Nephritis, Interstitial / Q000150:complications; D011446:Prospective Studies; D017582:Renal Replacement Therapy