Acute kidney failure: a pediatric experience over 20 years

Arch Pediatr Adolesc Med. 2002 Sep;156(9):893-900. doi: 10.1001/archpedi.156.9.893.


Background: Acute kidney failure in children is a catastrophic, life-threatening event.

Objective: To compare and contrast 2 decades of data, analyzing the underlying causes, associated multiple organ system failures, outcome of dialysis procedures, and other variables of interest.

Design: Retrospective examination of clinical data collected between January 1, 1979, and December 31, 1998.

Setting: Regional health care center in the mid-Atlantic area.

Participants: Two hundred twenty-eight patients, aged from 1 day to 18 years, had acute kidney failure and were referred to a pediatric nephrology service.

Main outcome measures: Characteristics, percentage of mortality, intensive care unit admission, procedures, and other variables and causes of acute renal failure.

Results: The total number of cases analyzed represented 7% of all patients presented to the pediatric nephrology service. Sex distribution, ethnicity, and survival statistics were unchanged between both decades. The overall survival rate was 73%. One hundred fifty-four patients (68%) were admitted to the pediatric intensive care unit. The following 106 acute extracorporeal procedures were performed on 93 patients (41%): 12 patients received extracorporeal membrane oxygenation, 52 patients underwent peritoneal dialysis, 32 underwent hemodialysis, 3 patients received continuous venovenous hemofiltration, and 7 patients received continuous arteriovenous hemofiltration. Sepsis and burns, other leading causes of acute renal failure in the first decade, are replaced in the second decade by hematologic-oncologic complications and pulmonary failure.

Conclusions: Acute kidney failure following repair of cardiac lesions remains unchanged as a leading risk factor of mortality in both decades. Three organ system failures were associated with more than a 50% mortality rate. Predialysis low serum albumin concentrations emerged as a significant copredictor of mortality.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Acute Kidney Injury / blood
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / mortality*
  • Acute Kidney Injury / therapy
  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Renal Replacement Therapy / methods
  • Renal Replacement Therapy / trends
  • Retrospective Studies
  • Risk Factors
  • Serum Albumin / metabolism
  • Survival Analysis
  • Virginia / epidemiology


  • Serum Albumin