Acute renal failure in the paediatric intensive care unit.

AIMS: To review a group of children with acute renal failure (ARF) requiring renal replacement therapy in a paediatric intensive care unit (PICU).

METHODS: Case records of children admitted to paediatric intensive care unit between January 1992 and July 1995 were reviewed for demography, diagnosis, modality of treatment, duration, complications of therapy and renal outcome. Long term follow up was sought from patients' referring paediatricians.

RESULTS: Twenty children with a mean age of 2 years and 3 months required acute renal replacement therapy. The most common cause was diarrhoea associated haemolytic uraemic syndrome with a mean duration of dialysis of 11.5 (SD 3.1) days (range 5-15. Four children had septicaemic illnesses; three with multiorgan system failure, one of whom died. Peritoneal dialysis was the only modality in 16 patients and four children were treated with continuous venovenous haemofiltration. Eight of the 20 patients were discharged from the paediatric intensive care unit with normal renal function as judged by serum creatinine. Long-term follow up showed normalisation of serum creatinine in a further eight of ten patients.

CONCLUSIONS: The most common cause of acute renal failure was diarrhoea associated haemolytic uraemic syndrome with an excellent outcome (100% patient survival). Children who had acute renal failure due to other illnesses had a higher mortality (27%).