Etiology and outcome of chronic renal failure in Indian children

A prospective analysis of all new pediatric cases of chronic renal failure (CRF) was performed at our hospital over a 1-year period. The diagnosis of CRF was based on serum creatinine >2 mg/dl with supportive clinical, labora tory, and radiological findings. There were a total of 48 patients with CRF with a median age of 13 years (range 10 days to 16 years). The causes of C RF included glomerulonephritis (37.5%), obstruction and interstitial (52%), hereditary (6.3%), and undetermined (4.2%). Patients were symptomatic for a mean of 33.2 months (range 10 days to 11 years) at presentation. Eight pa tients (16.7%) had acute reversible deterioration of renal function at pres entation. This was due to accelerated hypertension in 2, infection in 3, vo lume depletion in 2, and nonsteroidal antiinflammatory drugs in 1 patient. At presentation, 22 (46%) children had mild to moderate renal failure and 2 6 (54%) had end-stage renal disease. Twenty-one children (43.7%) had associ ated illness at presentation. Mean follow-up was 22.9 weeks (range 2-126 we eks). At the end of the study period, 10 (21%) patients were on conservativ e treatment, 7 (14.6%) on maintenance dialysis, 8 (16.7%) patients had func tioning allografts, 4 (8.3%) patients had died, and 19 (39.6%) opted agains t further therapy. We conclude that CRF in Indian children carries a poor p rognosis due to late referral and the limited availability and high cost of renal replacement therapy.