Prognosis of Children with Acute Renal Failure: A Study of 138 Cases

Abstract

Acute renal failure (ARF) in children has a poor prognosis in spite of modern therapeutic techniques. For this reason, it would be useful to have prognostic indicators early in the course of the disease, in order to identify those patients that could benefit most from aggressive treatment. In an attempt to establish valid prognostic factors, we prospectively studied 138 cases of ARF in children. We examined age, sex, etiology of ARF, previous surgery, prerenal origin, clinical situation of the patient when first seen by the nephrologist and complications. All these variables were statistically analyzed individually by univariate tests and, except for sex and complications, also by multiple regression analysis. Median age of the patients was 26 months. The etiology of ARF was nephropathy in 16, tumor in 14, cardiopathy in 85 and other causes in 23 cases. For analysis, patients were divided into patients with and without prerenal ARF. In the prerenal group, mortality-related factors were hypotension, need for ventilatory support, age less than 1 month and serum values of creatinine. In the nonprerenal ARF group, the need for assisted ventilation and the need for dialysis correlated positively with the mortality, while an exclusive nephrological etiology was associated with less probability of death.

Prognosis for children with acute kidney injury in the intensive care unit

“…Univariate analysis showed that the incidence of oliguria in our patients increased the risk of mortality by a multiple of 2.24 and that the incidence of anuria increased the risk of mortality by a multiple of 1.9. This association was observed by others [3, 5, 6, 12-14, 24, 31, 32] and is in contrast to results reported by Gallego et al [33]. Chew et al [12] carried out a detailed study and reported that of all the parameters of renal injury, oliguria was the most important and carried the greatest weight in multivariate analyses [12,34].…”

AKI in Hospitalized Children

“…Most pediatric studies have been from single centers and are limited by small sample size and a propensity to focus only on critical care populations or children who require dialysis (2,(14)(15)(16)(17)(18)(19)(20)(21)(22). Studies have suggested that the epidemiology of pediatric AKI has changed dramatically over the past few decades, noting that sepsis, congenital heart disease, and oncologic illness have replaced hemolytic uremic syndrome, GN, and primary renal diseases as the most common causes of AKI in hospitalized children (14,23).…”

Low-dose theophylline increases urine output in diuretic-dependent critically ill children

“…Conventional diuretics are used to augment urine output in these patients, but relative oliguria often persists and withdrawal of diuretic therapy may lead to clinical deterioration in multiple organ systems. Fluid imbalance can impair the ability of clinicians to deliver adequate nutrition and significantly increases the risk of mortality and morbidity in diureticdependent patients [1,2]. Effective alternative diuretics utilizing novel mechanisms of action may allow clinicians to minimize the toxicities of conventional diuretics in oliguric critically ill patients.…”