Renal and post-renal causes of acute renal failure in children.
OBJECTIVE
To identify the causes of acute renal failure (ARF) in pediatric population along with the identification of the age and gender most affected by the failure.


METHODS
Descriptive study.


METHODS
This study was carried out at the Pediatric Medical Ward of National Institute of Child Health (NICH), Karachi over a period of two years from 1996 to 1998.


METHODS
The study included children under the age of 12 years who presented with signs and symptoms suggestive of ARF (oliguria/anuria, vomiting, acidotic breathing etc.) along with raised blood urea nitrogen (BUN) serum creatinine and metabolic acidosis as shown by arterial blood gases (ABGs). Patients were divided into two groups on the basis of age; group A consisting of 0-2 years and group B from >2 years. Patients presenting with transient pre-renal azotaemia were excluded from the study. After providing initial emergency cover, detailed history, physical examination and investigations were carried out according to a proforma specially designed to ascertain the cause of ARF. Patients were managed for ARF as per standard recommendations and investigations completed or repeated as and when required.


RESULTS
A total of 119 patients with ARF were admitted in the ward over a period of two years constituting 1.36% of the total admissions and 16.39% of the admissions due to renal pathology. Mean age of presentation was 4.5 years with 56.7% of the patients under the age of 5 years. Male predominance was noted in all ages with an overall male to female ratio of 2.3:1. Most common cause leading to ARF in younger age group was found to be hemolytic uremic syndrome [25(54.34%)] followed by septicemia [7(15.21%)]. In older patients renal calculus disease was the most common [22(30.13%)] underlying pathology followed by pre-existing, undiagnosed chronic renal failure [16(21.91%)]. More than 90% of cases were related, directly or indirectly, to infections.


CONCLUSIONS
ARF is fairly common in children especially under the age of 5 years showing a male predominance. More than 90% of the cases can be prevented by improving primary health care and by early and prompt treatment of infections.
Jamal
Ammarah
A
Department of Paediatrics, Dow Medical College and Civil Hospital, Karachi-75400, Pakistan. drasjpk@yahoo.com
Ramzan
Afroze
A
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000175:diagnosis; D006801:Humans; D015994:Incidence; D007223:Infant; D007669:Kidney Calculi / Q000150:complications / Q000175:diagnosis; D007677:Kidney Function Tests; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000382:microbiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate