Acute renal failure in children: outcome and prognostic factors
Keywords:
acute renal failure, children, outcome, prognostic factors
Abstract
Background Acute renal failure (ARF) is an emergency conditionwith a high mortality rate despite the long-known dialysis and ad-
vanced 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 affect-
ing 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 observa-
tion. We classified the outcome as cured, uncured, and dead. Ana-
lytical 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%), fol-
lowed 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 di-
alysis (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
References
1. Star RA. Treatment of acute renal failure. Kidney Int
1998;54:1817-31.
2. DuBose TD, Warnock DG Jr, Mehta RL, Bonventre JV,
Hammerman MR, Molitoris BA, et al. Acute renal fail-
ure in the 21 st century: recommendations for manage-
ment and outcomes assessment. Am J Kidney Dis 1997;
29:793-9.
3. Arbus GS, Farine M, Guignard JP. Acute renal failure.
In: Postlethwaite RJ, editor. Clinical paediatric nephrol-
ogy. 2 nd ed. Oxford: Butterworth - Heinemann Ltd;
1994. p. 248-65.
4. Siegel NJ, Van Why SK, Devarajan P. Acute renal fail-
ure. In: Holliday MA, Barrat TM, Avner ED, editors.
Pediatric nephrology. 3 rd ed. Baltimore: William &
Wilkins; 1994. p.1176-203.
5. Alatas H. Gagal ginjal akut. In: Alatas H, Wirya WIGN,
Tambunan T, Soedjatmiko, editors. Kedaruratan pada
penyakit ginjal anak. Proceedings of the 22 nd Pediatric
Continuing Medical Education, Medical School, Uni-
versity of Indonesia; 1990 Dec 7-8; Jakarta, Indonesia.
Jakarta: Bagian IKA FKUI; 1990. p. 59-72.
6. Liano F, Pascual J. The Madrid Acute Renal Failure Study
Group. Epidemiology of acute renal failure: a prospec-
tive, multicenter, community-based study. Kidney Int
1996;50: 811-8.
7. Levy EM, Viscoli CM, Horwitz RI. The effect of acute
renal failure on mortality a cohort analysis. JAMA
1996;275:1489-94.
8. Chertow GM, Christiansen CL, Clearly PD. Prognostic
stratification in critically ill patients with acute renal
failure requiring dialysis. Arch intern med
1995;155:1505-11.
9. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJM. The
French Study Group on Acute Renal Failure. Acute re-
nal failure in intensive care units: causes, outcome, and
prognostic factors of hospital mortality: a prospective,
multicenter study. Crit Care Med 1996;24:192-8.
10. Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A.
A simple estimate of glomerular filtration rate in chil-
dren derived from body length and plasma creatinine.
Pediatrics 1976;58:259-63.
11. Wassner SJ. Conservative management of chronic re-
nal insufficiency. In: Holliday MA, Barratt TM, Avner
ED, editors. Pediatric nephrology. 3 rd ed. Baltimore:
Williams & Wilkins; 1994. p. 1314-38.
12. Trihono PP. Penatalaksanaan gagal ginjal kronik pada
anak. In: Rauf S, Albar H, Adoe TH, Hasanuddin A,
editors. Proceedings of the 7 th National Symposium
on Pediatric Nephrology and the 8 th Pediatric Scien-
tific Meeting, Medical School, Hasanuddin Univer-
sity; 1998 June 26-27; Ujungpandang, Indonesia.
Ujungpandang: Bagian IKA FK UNHAS; 1998. p.
135-50.
13. Bahrun D. Hipertensi sistemik. In: Alatas H, Tambunan
T, Trihono P, Pardede SO, editors. Buku Ajar Nefrologi
Anak. 2 nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.
242-90.
14. Bock GH. Acute renal failure. In: Kher KK, Makker SP,
editors. Clinical pediatric nephrology. 1 st ed. New York:
Mc. Graw–Hill; 1992. p. 469-500.
15. Endre ZH. Acute renal failure. In: Whitworth JA,
Lawrence JR, Smith PK, editors. Textbook of renal dis-
ease. 2 nd ed. Edinburgh: Churchill Livingstone; 1994.
p. 303-24.
16. Alatas H. Gagal ginjal akut. In: Alatas H, Tambunan T,
Trihono P, Pardede SO, editors. Buku Ajar Nefrologi
Anak. 2 nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.
490-508.
17. Gallego N, Caballero R, Gallego A, Estepa R, Liano F,
Ortuno J. Prognosis of patients with acute renal failure
without cardiopathy. Arch Dis Child 2001;84:258-60.
18. Arora P, Kher V, Rai PK, Singhal MK, Gulati S, Gupta
A. Prognosis of acute renal failure in children: a multi-
variate analysis. Pediatr Nephrol 1997;11:153-55.
19. Fiaccadori E, Lombardi M, Leonardi S, Rotelli CF,
Tortorella G, Borghetti A. Prevalence and clinical out-
come associated with preexisting malnutrition in acute
renal failure: a prospective cohort study. J Am Soc
Nephrol 1999;10:581-93.
20. Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Rilley
LJ. Role of hypoalbuminemia and hypocholesterolemia
as copredictors of mortality in acute renal failure. Kid-
ney Int 1999;56:1058-63.
21. Alatas H. Acute renal failure due to jengkol intoxica-
tion in children. Paediatr Indones 1994;34:164-9.
22. Kaysen GA, Stevenson FT, Depner TA. Determinants
of albumin concentration in hemodialysis patients. Am
J Kidney Dis 1997;29:658-68.
23. Bologa RM, Levine DM, Parker TS, Cheigh JS, Serur
D, Stenzel KH, et al. Interleukin-6 predicts hypoalbu-
minemia, hypocholesterolemia, and mortality in hemo-
dialysis patients. Am J Kidney Dis 1998;32:107-14.
24. Chevalier RL, Champbell F, Brenbridge ANAG. Prog-
nostic factors in neonatal acute renal failure. Pediatrics
1984;74:265-72.
1998;54:1817-31.
2. DuBose TD, Warnock DG Jr, Mehta RL, Bonventre JV,
Hammerman MR, Molitoris BA, et al. Acute renal fail-
ure in the 21 st century: recommendations for manage-
ment and outcomes assessment. Am J Kidney Dis 1997;
29:793-9.
3. Arbus GS, Farine M, Guignard JP. Acute renal failure.
In: Postlethwaite RJ, editor. Clinical paediatric nephrol-
ogy. 2 nd ed. Oxford: Butterworth - Heinemann Ltd;
1994. p. 248-65.
4. Siegel NJ, Van Why SK, Devarajan P. Acute renal fail-
ure. In: Holliday MA, Barrat TM, Avner ED, editors.
Pediatric nephrology. 3 rd ed. Baltimore: William &
Wilkins; 1994. p.1176-203.
5. Alatas H. Gagal ginjal akut. In: Alatas H, Wirya WIGN,
Tambunan T, Soedjatmiko, editors. Kedaruratan pada
penyakit ginjal anak. Proceedings of the 22 nd Pediatric
Continuing Medical Education, Medical School, Uni-
versity of Indonesia; 1990 Dec 7-8; Jakarta, Indonesia.
Jakarta: Bagian IKA FKUI; 1990. p. 59-72.
6. Liano F, Pascual J. The Madrid Acute Renal Failure Study
Group. Epidemiology of acute renal failure: a prospec-
tive, multicenter, community-based study. Kidney Int
1996;50: 811-8.
7. Levy EM, Viscoli CM, Horwitz RI. The effect of acute
renal failure on mortality a cohort analysis. JAMA
1996;275:1489-94.
8. Chertow GM, Christiansen CL, Clearly PD. Prognostic
stratification in critically ill patients with acute renal
failure requiring dialysis. Arch intern med
1995;155:1505-11.
9. Brivet FG, Kleinknecht DJ, Loirat P, Landais PJM. The
French Study Group on Acute Renal Failure. Acute re-
nal failure in intensive care units: causes, outcome, and
prognostic factors of hospital mortality: a prospective,
multicenter study. Crit Care Med 1996;24:192-8.
10. Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A.
A simple estimate of glomerular filtration rate in chil-
dren derived from body length and plasma creatinine.
Pediatrics 1976;58:259-63.
11. Wassner SJ. Conservative management of chronic re-
nal insufficiency. In: Holliday MA, Barratt TM, Avner
ED, editors. Pediatric nephrology. 3 rd ed. Baltimore:
Williams & Wilkins; 1994. p. 1314-38.
12. Trihono PP. Penatalaksanaan gagal ginjal kronik pada
anak. In: Rauf S, Albar H, Adoe TH, Hasanuddin A,
editors. Proceedings of the 7 th National Symposium
on Pediatric Nephrology and the 8 th Pediatric Scien-
tific Meeting, Medical School, Hasanuddin Univer-
sity; 1998 June 26-27; Ujungpandang, Indonesia.
Ujungpandang: Bagian IKA FK UNHAS; 1998. p.
135-50.
13. Bahrun D. Hipertensi sistemik. In: Alatas H, Tambunan
T, Trihono P, Pardede SO, editors. Buku Ajar Nefrologi
Anak. 2 nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.
242-90.
14. Bock GH. Acute renal failure. In: Kher KK, Makker SP,
editors. Clinical pediatric nephrology. 1 st ed. New York:
Mc. Graw–Hill; 1992. p. 469-500.
15. Endre ZH. Acute renal failure. In: Whitworth JA,
Lawrence JR, Smith PK, editors. Textbook of renal dis-
ease. 2 nd ed. Edinburgh: Churchill Livingstone; 1994.
p. 303-24.
16. Alatas H. Gagal ginjal akut. In: Alatas H, Tambunan T,
Trihono P, Pardede SO, editors. Buku Ajar Nefrologi
Anak. 2 nd ed. Jakarta: Balai Penerbit FKUI; 2002. p.
490-508.
17. Gallego N, Caballero R, Gallego A, Estepa R, Liano F,
Ortuno J. Prognosis of patients with acute renal failure
without cardiopathy. Arch Dis Child 2001;84:258-60.
18. Arora P, Kher V, Rai PK, Singhal MK, Gulati S, Gupta
A. Prognosis of acute renal failure in children: a multi-
variate analysis. Pediatr Nephrol 1997;11:153-55.
19. Fiaccadori E, Lombardi M, Leonardi S, Rotelli CF,
Tortorella G, Borghetti A. Prevalence and clinical out-
come associated with preexisting malnutrition in acute
renal failure: a prospective cohort study. J Am Soc
Nephrol 1999;10:581-93.
20. Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Rilley
LJ. Role of hypoalbuminemia and hypocholesterolemia
as copredictors of mortality in acute renal failure. Kid-
ney Int 1999;56:1058-63.
21. Alatas H. Acute renal failure due to jengkol intoxica-
tion in children. Paediatr Indones 1994;34:164-9.
22. Kaysen GA, Stevenson FT, Depner TA. Determinants
of albumin concentration in hemodialysis patients. Am
J Kidney Dis 1997;29:658-68.
23. Bologa RM, Levine DM, Parker TS, Cheigh JS, Serur
D, Stenzel KH, et al. Interleukin-6 predicts hypoalbu-
minemia, hypocholesterolemia, and mortality in hemo-
dialysis patients. Am J Kidney Dis 1998;32:107-14.
24. Chevalier RL, Champbell F, Brenbridge ANAG. Prog-
nostic factors in neonatal acute renal failure. Pediatrics
1984;74:265-72.
Published
2016-10-10
How to Cite
1.
Trihono P, Soesilo O, Suradi R. Acute renal failure in children: outcome and prognostic factors. PI [Internet]. 10Oct.2016 [cited 26Apr.2024];43(6):205-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/693
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Received 2016-09-24
Accepted 2016-09-24
Published 2016-10-10
Accepted 2016-09-24
Published 2016-10-10
