Peritonitis as a risk factor of acute renal failure in nephrotic children

Idiopathic acute renal failure (IARF) is an uncommon but severe complicatio n in children with relapsing nephrotic syndrome and may require long-term d ialytic support until recovery of renal function takes place. Due to limite d understanding of the pathophysiology of IARF, specific guidelines for its prevention and therapy have not been developed. Among triggering factors, peritonitis was present in half of all pediatric patients with this complic ation described in the English literature over the past 15 years. We report an additional nephrotic child who developed IARF following spontaneous bac terial peritonitis. The renal biopsy showed tubular epithelial changes cons istent with acute tubular necrosis. A discussion of related literature and possible pathogenesis of this association is presented.