Acute renal failure in children: outcome and prognostic factors

Background Acute renal failure (ARF) is an emergency condition with a high mortality rate despite the long-known dialysis and advanced supportive care. Only few studies on prognostic factors of ARF in children are available in the literature, which are difficult to compare to each other due to the different definitions of the ARF outcome used. Objective To find out the clinical and laboratory characteristics of children with acute renal failure and the prognostic factors affecting the outcome. Methods This observational prospective study was conducted on children with acute renal failure hospitalized in the Department of
Child Health, Cipto Mangunkusumo Hospital, between July and December 2001. Patients with acute on chronic renal failure were excluded. Clinical and laboratory data were taken at the time of diagnosis and the outcomes were noted after 2 weeks of observation. We classified the outcome as cured, uncured, and dead. Analytical study was done to find out the relationships among various prognostic factors. Results Fifty-six children with ARF were recruited in this study. Male to female ratio was 1.3:1; the mean age was 4.4 year-old. The most frequent presenting symptom was dyspnea (34%), followed by oliguria (29%). The most frequent primary disease was malignancy (20%). Most of the patients had renal-type of ARF (73%). The outcomes were cure (71%), no cure (16%), and death (13%). Bivariate analysis and logistic regression revealed that younger age (OR=13.6; 95%CI 1.01;183.60) and the need for dialysis (OR=10; 95%CI 1.53;65.97) had significant relationships with mortality or no cure. Conclusion We should be aware when finding ARF patients less than 5 year-old and have the indications for dialysis, due to the poor prognosis they might have.