Chronic renal failure in children.
OBJECTIVE
To determine the etiology of chronic renal failure amongst children attending the Pediatric Nephrology services at a tertiary care center.


METHODS
We reviewed the records of 305 children, diagnosed to have chronic renal failure (CRF) over a 7-year period. CRF was defined as glomerular filtration rate (GFR) below 50-mL/1.73 m2/min persisting for more than 3 months.


RESULTS
The mean age at onset and presentation of CRF in these patients was 5.9 and 8 years respectively. Ninety-six children were below 5 years of age. Mean (SD) levels of blood urea and creatinine at presentation were 150 and 4.6 mg/dL respectively. The median GFR at presentation was 18.5 mL/min/1.73 m(2) while 25.3 patients were already in end stage renal failure indicating that these patients were referred late. The mean (SD) hemoglobin at presentation was 7.6 (2.6) g/dL. The mean height and weight SD scores were 2.9 and 2.4 respectively. Obstructive uropathy was the commonest cause of CRF present in 97 children. Other causes included chronic glomerulonephritis in 84, reflux nephropathy in 51, hereditary nephritis in 20, renal dysplasia in 15 and hemolytic uremic syndrome in 5 children. The mean (SD) duration of follow-up was 11(15) months. Peritoneal or hemodialysis was performed in 63 patients. Fifteen patients underwent a live-related renal transplantation. The rest opted out of dialysis program and were conservatively managed due to financial constraints.


CONCLUSIONS
The commonest causes of CRF were obstructive and reflux nephropathy. A significant proportion of patients presented late; had severe CRF and were malnourished and stunted. Majority of these were managed conservatively due to lack of financial resources.
Hari
Pankaj
P
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. pankajhari@hotmail.com
Singla
Ish Kumar
IK
Mantan
Mukta
M
Kanitkar
Madhuri
M
Batra
Bobby
B
Bagga
Arvind
A
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis