Ten-year follow-up of children after acute renal failure from a developing country

Objective. The acute-stage mortality and morbidity of acute renal failure (ARF) is well documented, but there are few long-term follow-up studies in children with ARF, particularly from developing countries. The aim of this study was to look at the spectrum of ARF on presentation at a tertiary centre in Kolkata, India, with subsequent 10 years of follow-up. Subjects and methods. All cases of ARF between the ages of 1 month and 10 years presenting between April and September 1996 were included. We did exclude children with any known renal abnormality. The study group was subsequently monitored for renal survival and mortality until 10 years post-ARF episode. Results. A total of 37 (n = 37) cases were enrolled. Glomerulonephritis and snakebite were the two most common aetiologies (n = 17 and n = 9). The acute mortality was 35% (n = 13), and it was significantly associated with peak creatinine and presence of multiple organ failure (P < 0.05). The outcome at 6 months could be assessed for 92% (n = 22) of acute survivors and at 10 years for 67% (n = 16). The children that were traced showed in 32% (n = 7) at 6 months and 38% (n = 6) at 10 years, respectively, at least one of the four (abnormal creatinine, hypertension, haematuria and proteinuria) abnormal renal parameters. Snakebite, acute-stage peak creatinine and duration of oliguria were significantly associated with adverse long-term outcome (P < 0.05). Conclusion. We found that nearly 25% (n = 6) of the survivors of an acute episode of renal failure had renal morbidity after 10 years, a percentage significant enough for these children to need long-term follow-up.