Ammarah Jamal, Afroze Ramzan Sherali.
The immediate outcome of acute renal and post renal failure and predictors of the outcome.
Pak Paed J Jan ;32(2):123-32.

Objective: To determine the immediate outcome of renal and post renal causes of acute renal failure (ARF) and to determine the factors affecting the outcome of the ARF. Study design: This is a descriptive observational type of study. Place and duration: Paediatric Medicine Unit of National Institute of Child Health (NICH), Karachi over a period of two years. Material & Methods: The study included all patients 0-12 years of age who were admitted in the paediatric medical ward with the diagnosis of Acute Renal Failure (ARF). The diagnosis of ARF was based on signs and symptoms suggestive of ARF along with metabolic acidosis and rising serum creatinine level. The patients were divided into two age groups; Group A, 0-2 years of age, Group B, >2-12 years of age. After providing initial emergency cover, detailed history, physical examination and relevant investigations were carried out according to a proforma especially designed to ascertain the cause of ARF. Management was mainly supportive. Percutaneous nephrostomy, peritoneal dialysis or haemodialysis was performed where indicated. The patients were then followed up for about two weeks to note the immediate outcome of ARF in terms of normalization of renal function, persistent renal impairment and mortality. Results: A total of 101 patients of ARF were included in the study. 6 patients left against advice before the completion of management and thus were excluded from the study. Mortality among group A patients was 34.14%. Septicemia was associated with the highest mortality followed by Haemolytic Uraemic Syndrome (HUS). Posterior Uretherel Valves (PUV)/ Vesico-ureteric Reflux (VUR) carried the best prognosis along with Acute Tubular Necrosis (ATN). Peritoneal dialysis in group A was associated with a better prognosis in terms of mortality as compared to the conservatively managed patients. Forty six percent of patients in group A had normalization of renal function while 19.51% were left with persistent renal impairment. Thirty three percent of the patients in group B had normalization of renal function while 55.55% were left with persistent renal impairment. Mortality in group B was 11.11%. Septicemia, snakebite and rapidly progressive glomerulonephritis (RPGN) all were associated with 100% mortality. None of the older patients among the conservatively managed group expired. Survival was found to be associated mainly with the younger age, underlying pathology, severity of the disease and the level of consciousness. The survival was better in nonoliguric patients while nutritional status of the child did not seem to affect the survival in this study Conclusion: ARF is associated with a high overall mortality of 20.35%. Overall, about 40% of the surviving patients are left with impaired renal function in immediate recovery period.

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