PAEDIATRIC ACUTE RENAL FAILURE IN FRONTIER PROVINCE

Objective:. This study was taken to evaluate etiology, presentation, complication and outcome of the patients suffering from Acute Renal Failure.Material and Methods: A total of 50 patients, suffering from acute renal failure, ranging from 3-15 years of age, were evaluated of age for period of 3 years (1998-2000) at Nephrology Department, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. Peritoneal dialysis was the main modality of treatment. Kidney biopsies were performed in 22% of the cases. Patients with history of renal insufficiency, urological surgery were excluded from the study.Results: Out of 50 patients male out numbered the female by ratio of 2:1 with mean age of 9.48 years and peak age of 6-8 years. On admission, the presenting features of patients were fever 62%, azotemic symptoms 46%, fluid overload 46%, hypertension 40%, oliguria 38%. Etiologically gastroenteritis 20%, septicemia 16%, AGN 16%, HUS 12%, crescentric nephritis 10% were responsible for acute renal failure in our population, where as malaria and obstructive nephropathy contributed in 8% of the cases. 68% of the patients were offered renal replacement therapy. 32% were managed conservatively. Peritoneal dialysis was the cost effective mode of treatment, carrying a mortality of 22% compared of hemodialysis with mortality of 50%. 11 out of 50 patients had kidney biopsy showing crescentric nephritis as an important histological feature in 4 cases. 5 out of 11 patients who had kidney biopsy eventually died. 12 patients expired representing mortality of 24%.Conclusion: Paediatric Acute Renal Failure is a serious medical emergency. Late referral, malnutrition, lack of faculties at periphery hospital and poor socio-economic condition contribute to high mortality. Earlyreferral, fluid balance, close monitoring of BP, keeping GN as a possibility in paediatric population with hypertension and judicious use of fluids in an oligouric child with renal failure is the best way to prevent further damage.