Acute kidney injury (AKI; previously called acute renal failure) is characterised by a usually reversible increase in the blood concentration of creatinine and nitrogenous waste products and by the inability of the kidneys to appropriately regulate fluid and electrolyte homeostasis [1].

We conducted a study in the department of Nephrology and Neonatology, SKIMS, Soura, Srinagar Kashmir over a period of two and half years from 2006 to 2008.Hundred (100) cases of children up to the age of 18 years with ARF admitted in SKIMS were studied. The minimum age was 1 day and the maximum age was 18 years. 36% patients were <2 years, 6% 2-5 years, 27% 5-10 years and 31% >10 years. The diagnosis of ARF was based on rapidly progressive azotemia (rise of serum creatinine by at least 0.5/dL/day or BUN rise by 10 mg/dl/day or serum creatinine more than 2 mg/dl and usually but not always associated with oliguria [2,3]. After providing initial emergency care, detailed history, physical examination and investigations were carried out to determine the cause of ARF. Oliguria was the commonest clinical presentation present in 60% patients followed by edema (45%). Anuria was present in 13% of patients.33% were dehydrated with 11% having severe dehydration. 20% patients had hypertention on presentation.

Table I shows the etiology of ARF and the associated mortality. ATN was the commonest (33%) cause of ARF in our patients especially in children <5 years of age. Sepsis was the commonest cause of ATN (45%) followed by birth asphyxia (18.18%) and acute gastroenteritis (AGE) (15.15%). Above 10 years, glomerulonephritis was the leading cause (16%) of ARF. Post-operative and post-renal causes of ARF comprise very low percentage (each 8%); same observations have been made by Srivastava, [4]. Drug induced renal failure comprise 5% of cases. Most cases were managed conservatively, while RRT in the form of peritoneal and hemodialysis was done in 20 cases. Mortality rate was 20%; same as observed by Ihab Sakr Shaheen, et al. [5]. ATN has the highest proportion of death (p.value 0.003) comparable with other study [6]. Survival was better in older children than in younger ones.

We conclude that even today, sepsis is the most common cause of ARF followed by AGE in this part of the world. If these conditions are treated early and promptly, the occurrence of ARF can be prevented. If the patient develops ARF, an early referral to a specialised centre with dialysis facility can significantly improve the final outcome.

1. Andreoli SP. Acute kidney injury in children. Pediatr Nephrol.2009;24:253-63.

2. Shah BV, Almeida AF. Acute renal failure in pediatric population in tropics. Postgrad Med. 1985;31:134-9.

3. Arora P, Kher V, Gupta A. Pattern of acute renal failure at a referral hospital. Indian Pediatr. 1994;31:1047-53.

4. Srivastava RN, Moudgil A. Hemolytic uremic syndrome (HUS) in children in northern India. Pediatric Nephrol. 1991;5:284-8.

5. Shaheen IS, Watson AR. Acute renal failure in children: Etiology, treatment and outcome. Saudi J Kidney Dis Transplant. 2006;17:153-8.