Irfan Waheed Kh A, Khadija Irfan, Tahir Masood Ahmad, Humayun Igbal Khan.
Spectrum of clinical presentation of Chronic Renal Failure in children.
Pak Paed J Jan ;26(4):167-71.

Chronic renal failure (CRF) in children is often difficult to recognize at an early stage because of the subtle and varied modes of presentation, leading to a delay in the diagnosis of this grave but not uncommon condition. The importance of diagnosing CRF at an early stage lies in the fact that appropriate management may retard the progression of the disease and delays need for renal replacement therapy. We conducted a prospective study from 1991 to 2000 on 135 children in the Department of Paediatrics, King Edward Medical College & Mayo Hospital, Lahore. The initial clinical presentation of 135 consecutive patients with CRF was studied. The criterion for inclusion in the study was a sustained elevation of serum creatinine for more than three months in patients aged less than 18 years of age. Common presentations of childhood CRF in our study included dyspnoea (54.8%), fever (52.6%), vomiting (29.6%), oedema (29.6%), seizures (17.8%), pallor (17.8%), bleeding diathesis (16.3%) and growth retardation (14.8%); uncommon presentations included oliguria (13.3%), polyuria (10.4%), tetany (4.4%) and bony fractures (0.7%). Data analysis for age correlation yielded dyspnoea as the commonest presentation at all ages followed by fever, failure to thrive and oedema in infants (3m-1 yr.), preschoolers (>1-5 yrs.) and older children (>5-18 yrs.) respectively. It was concluded that a large majority of our patients present with serious complications, and that earlier symptoms often go unrecognized. We recommend that surveillance programmes for CRF be instituted at outpatient level with aggressive search for patients with earlier, more subtle symptoms.

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