Acute renal failure (ARF) is the acute loss of renal function over a period of hours or days. Given the poor prognosis of ARF among children, there is some urgency to identifying more effective prognostic indicators for detecting disease onset. Such indicators would help provide the means of selecting patients who would benefit the most from early aggressive treatment. In this study we assessed the etiologic and prognostic indicators of ARF, including several risk factors such as sepsis, respiratory distress, age, among others, in 300 children who were admitted to the Ali Asghar Children’s Hospital, Tehran, Iran, from 1990 to 2003. Statistical analysis was performed using multiple regression and chi-square methods, and a score to determine the prognosis of ARF in children was developed. Result: Based on the results of this study the three common causes of ARF are acute tubular necrosis (ATN, 38%), acute glumerulonephritis (24%) and hemolytic uremic syndrome (24.1%). The overall mortality rate among our patients was 24.7%, with the highest risk group being those patients suffering from ischemic ATN. In addition, the correlation (p<0.0005) between the etiology and mortality rate was particularly high in patients with ischemic ATN. Mortality was also high (68%) in children younger than 2 years. Multiple regression models revealed that among those factors that significantly differed between the survivors and nonsurvivors, only the necessity of dialysis (p<0.0005), the use of mechanical ventilation (p=0.05) and disseminated intravascular coagulation (p=0.038) can be regarded as independent determinants of ARF prognosis in children.
Offner G, Brodehl J, Galaske R, Rutt T (1986) Acute renal failure in children: prognostic features after treatment with acute dialysis. Eur J Pediatr 144:482–486CrossRefGoogle Scholar
Flynn JT, Kershaw DB, Smoyer WE, Brophy PD, McBryde KD, Bunchman TE (2001) Peritoneal dialysis for management of pediatric acute renal failure. Perit Dial Int 21:390–394PubMedGoogle Scholar
Barratt TM, Avner ED, Harmon WE (1999) Pediatric nephrology, 4th edn. Lippincott Williams and Wilkins, Philadelphia, pp 1119–1133Google Scholar
Liano F, Junco E, Pascual J, Madero R, Verde E (1998) The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings: The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 66:S16–S24PubMedGoogle Scholar
Honda N, Hishida A (1993) Pathophysiology of experimental nonoliguric acute renal failure. Kidney Int 43:513–521CrossRefGoogle Scholar
Stapleton FB, Jones DP, Green RS (1987) Acute Renal Failure in neonates: incidence, etiology and outcome. Pediatr Nephrol 1:314–320CrossRefGoogle Scholar
Cantarovich F, Verho MT (1996) A simple prognostic index for patients with acute renal failure requiring dialysis. French Multicentric Prospective Study on Furosemide in Acute Renal Failure Requiring Dialysis. Ren Fail 18:585–592CrossRefGoogle Scholar