A REVIEW OF ACUTE-RENAL-FAILURE IN CHILDREN - INCIDENCE, ETIOLOGY ANDOUTCOME

We reviewed our experience of children with acute renal failure. St Ja mes's University Hospital, Leeds, UK is a tertiary referral center tha t serves a relatively stable regional population (former Yorkshire reg ion). It is a mixed rural and urban population providing a unique prof ile of the nature of the cases and workload experienced. The data is e xpressed as a function of age and compared against a previous era of p aediatric nephrology and current adult incidence data. Over an 8-year period (1984-1991) 227 children were referred for dialysis management of acute renal failure. The yearly incidence was 0.8 per 100,000 total population. Acute renal failure in the child population was almost a fifth of the adult incidence. Age-related incidence however shows the highest incidence in the neonate/infant population and is comparable t o adult data. The intensive care unit was needed for nearly half the c hildren. For all ages hemolytic uremic syndrome was the commonest caus e (45%). Surgery for congenital heart disease was predominant (63%) in the neonate group. The overall mortality was 25%. Primary renal disea se accounts for only 7% of the etiologies and was the source for the m ajority that went on to require chronic renal replacement therapy. Acu te renal failure is nearly always a secondary event in the face of oth er organ failure and the majority of the mortality arises from surgery for congenital heart disease. If the underlying condition is treatabl e: the prognosis for recovery from acute renal failure with appropriat e supportive care is excellent.