| Abstract|| |
Acute renal failure (ARF) is a common problem in the Congo. This is a sixyear retrospective study aiming at analyzing the etiology and the outcome of ARF at the Brazzaville's University Hospital from 1989 through 1994. One hundred and five cases of ARF (0.99%), including 54 boys (51.4%) and 51 girls (48.6%), out of 10,512 children admitted in the department of Pediatrics have been recorded. ARF represented 13.09% of the causes in 802 patients with renal disorder. The main etiologies of ARF included acute gastroenteritis with dehydration (25.7%), nephrotic syndrome (14.7%), sepsis (15.23%), malaria (12.38%), and acute glomerulonephritis (9.5%). Most cases were managed conservatively, while peritoneal dialysis (PD) was used in eight cases (7.62%). The outcome of ARF was recovery in 50.5 %, death in 37 % and chronic renal failure in 12.5% of cases. Preventive measures may help in reducing the high mortality rate and the need for dialysis.
Keywords: Acute renal failure, Children, Africa, Congo, Brazzaville.
|How to cite this article:|
Assounga AG, Assambo-Kieli C, Mafoua A, Moyen G, Nzingoula S. Etiology and Outcome of Acute Renal Failure in Children in Congo-Brazzaville. Saudi J Kidney Dis Transpl 2000;11:40-3
|How to cite this URL:|
Assounga AG, Assambo-Kieli C, Mafoua A, Moyen G, Nzingoula S. Etiology and Outcome of Acute Renal Failure in Children in Congo-Brazzaville. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2020 Aug 4];11:40-3. Available from: http://www.sjkdt.org/text.asp?2000/11/1/40/36691
| Introduction|| |
Although common in Africa, acute renal failure (ARF) has not been well studied. Only few studies have been published on Africans. , The lack of specialized nephrology services and nephrologists may account for this fact. Pediatric nephrology is even less popular and the high cost of treating patients with renal disease is prohibitive. Treating renal diseases is usually perceived to be beyond the reach of most African countries. In addition, epidemiological data necessary for making sound health policies are still lacking. Therefore, such studies, with the aim of establishing the etiology and magnitude of the major diseases, are needed in order to guide the allocation of the limited health resources. Recently, we reported on nephropathy in patients in Congo according to the HIV status.  ARF represented 19% of adult admissions for nephropathies. CongoBrazzaville is a central African country with an equatorial and tropical climate. The total population is about 2.9 million composed mainly of blacks of bantou subgroup.
The aim of this work is to analyze the etiologies and outcome of acute renal failure in children in Brazzaville's University Hospital, which serves a population of 1.5 million.
| Materials and Methods|| |
We reviewed the records of patients hospitalised with acute renal failure, in the department of Pediatrics, from June 1989 through December 1994. There were 105 patients; 54 males and 51 females of age ranging from 1 month through 17 years, out of 802 patients with renal disorders (13.09%) and of 10,512 admitted children (0.99%).
The criteria of diagnosis of ARF included a clinical history suggestive of recent deterioration of kidney function and/or recent increase of serum creatinine above 150 μmol/l in the presence of normal sized kidneys. Kidney biopsies and histologic examination were performed in few patients to deter-mine the pathology and etiology of ARF.
Conservative management included treatment of the underlying cause, if possible, correction of fluid and electrolytes imbalance, control of blood pressure and treatment of symptoms. Peritoneal dialysis was performed using a pediatric Tenckhoff catheter, or a rigid catheter in older patients, and a lactate containing dialysate. Half a liter to 2 liters of dialysis fluid of various glucose concentrations: 1.5%, 2.5%, 4.25% (Adcock-Ingram, Aeroton, Johannesburg, RSA) was used. Dwell-in time varied between 2 to 4 hours.
| Statistical Analysis|| |
Data were analyzed using X 2 method for group comparison.
| Results|| |
The most common etiology of ARF was infection, which was encountered in 70 out of 105 (66.7%). These included gastroenteritis, septicemia, malaria, acute glomerulonephritis, pyelonephritis and typhoid fever. The non-infectious causes of ARF were nephrotic syndrome, hemolytic uremic syndrome, nephrotoxic medications and lymphoma [Table - 1].
The classification of patients according to the probable physiopathology of ARF was acute tubular necrosis (31.4%) followed by renal hypoperfusion (28.6%) and glomerulonephritis (27.6%), [Table - 2]. Few patients admitted with renal hypoperfusion deteriorated to tubular necrosis despite therapy.
The outcome of ARF patients was recovery in 53 (50.5 %) patients, chronic renal failure in 13 (12.4%) and death in 39 (37.1%), [Table - 3]. Glomerulopathies had a large proportion of recovery while renal hypoperfusion and acute tubulonecrosis had the largest proportion of death (p<0.05).
This may be due to other associated pathologies. Patients who recovered did so in time duration ranging between four days and 72 days (mean of 30 days). Eighty three per cent of patients recovered a normal kidney function within seven days. The leading causes of death of patients were severe dehydration and cardiovascular collapse. Other causes included: pulmonary edema, hyperkalemia, severe anemia and septic shock [Table - 4].
| Discussion|| |
Infection as a cause of ARF has decreased over the years in countries like India from 23% to 10%. However, infection such as gastroenteritis still plays a major role in causing ARF in many developing countries. In our study, infections were the leading cause of acute renal failure in children, accounting for 67% of all causes. This was also the case in several other countries. ,,,, In few other studies hemolytic uremic syndrome was reported to be the leading cause of ARF, especially in infants. , The main infection was acute gastroenteritis associated with dehydration. ARF presents initially as pre-renal failure and, depending on the delay in the correction of dehydration, it may lead to acute tubular necrosis. Thadhani reported, in a review article, that tubular necrosis represents 85% of ARF, interstitial nephritis 10% and acute glomerulonephritis 5% of all renal parenchymal causes.  Malaria was another leading infection that caused ARF in our patients. The renal failure occurred either through gastroenteritis and dehydration or through severe acute hemolysis in the hemolytic uremic syndrome. However, post-renal causes of ARF were rare in our study. They accounted for only 3.8% of our ARF patients.
In many previous reports, ARF was associated with high mortality due largely to the underlying cause of the ARF rather than ARF itself. , In our study we encountered high mortality as well. Furthermore, few cases evolved toward chronic renal failure. They all were cases of ARF of noninfectious origin.
In most reports, the prognosis of ARF is still poor despite progress made in renal function replacement techniques. ,, However, only a small percentage of ARF patients in our study required dialysis. We believe that prevention of the causes of ARF as well as a good management of prerenal failure and post-renal failure can reduce this number further. Unfortunately, in some cases renal replacement therapy cannot be avoided. ,, Hemodialysis, hemofiltration or peritoneal dialysis should be offered to maintain the patient until his/her own kidneys resume function.
We conclude that ARF is an important cause of morbidity and mortality in children. Its prevention as well as an effective early management may help save lives. The knowledge of the scope of ARF is helpful in designing a realistic policy that may improve the prevention as well the management of ARF patients.
| References|| |
|1.||Seedat YK, Nathoo BC. Acute renal failure in blacks and Indians in South Africa comparison after 10 years. Nephron 1993;64:198-201. [PUBMED] |
|2.||Assounga AG, Yala F, Mongo Y, Assambo C, Mpio I. HIV and nephropathy in the Congo: a comparison of HIV-positive vs HIVnegative patients. Saudi J Kidney Dis Transplant 1996;7:S30-2. |
|3.||Gokalp AS, Oguz A, Gultekin A. Acute renal failure related to infectious disease in infancy and childhood. Ann Trop Paediatr 1991;11:119-21. [PUBMED] |
|4.||Gokcay G, Emre S, Tanman F, Sirin A, Eleioglu N, Dolunay G. An epidemiological approach to acute renal failure in children. J Trop Pediatr 1991;37:191-3. |
|5.||Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med 1996; 334:1448-60. [PUBMED] [FULLTEXT]|
|6.||Arora P, Kher V, Gupta A, et al. Pattern of acute renal failure at a referral hospital. Indian Pediatr 1994;31:1047-53. [PUBMED] |
|7.||Bourquia A, Zaid D. Acute renal insufficiency in children. Retrospective study of 89 cases. Ann Pediatr Paris 1993;40:603-8. |
|8.||Broyer M, Loirat C, Guesnum. L'insuffisance renale aigue In Nephrologie pediatrique 3rd ed., Flammarion Medicine Sciences, Paris 1983:415-25. |
|9.||Singh RG, Agarwal DK, Usha, Jha A, Dube B, Bhargava V. What decides: high mortality in pediatric acute renal failure? Kobe J Med Sci 1993;39:51-7. |
|10.||Gallego N, Gallego A, Pascual J, Liano F, Estepa R, Ortuno J. Prognosis of children with acute renal failure: a study of 138 cases. Nephron 1993;64:399-404. |
|11.||Ellis D, Gartner JC, Galvis AG. Acute renal failure in infants and children: diagnosis, complications and treatment. Crit Care Med 1981;9:607-17. [PUBMED] |
|12.||Reznik VM, Griswold WR, Peterson BM, Rodarte A, Ferris ME, Mendoza SA. Peritoneal dialysis for acute renal failure in children. Pediatr Nephrol 1991;5:715-7. [PUBMED] |
Alain G Assounga
Department of Medicine, Princess Marina Hospital, P.O. Box 258, Congo, Brazzaville, Africa
[Table - 1], [Table - 2], [Table - 3], [Table - 4]