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NDT Advance Access originally published online on January 8, 2008
Nephrology Dialysis Transplantation 2008 23(5):1575-1580; doi:10.1093/ndt/gfm863
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Aetiology and outcome of acute and chronic renal failure in infants

Mirja Wedekin, Jochen HH Ehrich, Gisela Offner and Lars Pape

Department of Pediatric Kidney-, Liver- and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany

Correspondence and offprint requests to: Lars Pape, Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany. Tel: +49-511-523-5706; Fax: +49-511-530-4830; E-mail: larspape{at}t-online.de



  Abstract

Background. The aetiology and outcome of acute (ARF) and chronic renal failure (CRF) in infants were analysed in a retrospective study.

Methods. Between January 1997 and April 2004 all children <1 year of age with a serum creatinine >100 µmol/l at Hannover Medical School were followed up for up to 6 years. One hundred and nineteen children with a serum creatinine >100 µmol/l were identified, 70 infants suffering from ARF and 49 from chronic kidney disease (CKD), stages 3–5.

Results. Renal failure was caused in 49/119 (41%) by congenital and in 70/119 (59%) by acquired diseases. The aetiology of ARF (n = 70) included cardiac (27%), prematurity (27%), septic (10%), hepatic (9%), renal (9%) and other (18%) causes. Twelve infants needed transient dialysis treatment. Renal function recovered in all surviving children. The mortality rate was 37%. Causes of death were unrelated to kidney function. Twenty-one of 49 infants with CKD were dialyzed with a median age of 65 days at the start of dialysis, and 23/49 children received a kidney transplant (RTx). The 5-year patient and graft survival for RTx-children of 95.5% was not different from older children. The 5-year patient survival rate of 26 children with CKD without RTx was 63%. The causes of death were parental refusal of therapy in neonates (n = 4) and life-threatening extra-renal comorbidity (n = 3).

Conclusion. Renal replacement therapy offers good chances of survival in infants without life-threatening comorbidity. Patient survival of infants treated for CKD in the first year of life was comparable to that of older children.

Keywords: dialysis; infants; kidney transplantation; terminal renal failure

Received for publication: 1. 8.07
Accepted in revised form: 14.11.07


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