Acute renal failure in children
with meningococcal septic shock
von
Rosenstiel IA, Frantzen S,
Groothoff JW
Department of Pediatric Intensive Care,
Emma Children’s Hospital, Academic Medical Center, Amsterdam, The
Netherlands
Objective:
The aim of this study was to determine the incidence of acute renal failure
(ARF) and the use of renal replacement therapy (RRT) in children with
meningococcal septic shock (MSS).
Methods:
Retrospective analysis of 105 children with MSS (all receiving inotropic
support) admitted to the PICU (January 1993-August 2000). ARF was
determined according to the Sepsis-related Organ Failure Assessment (SOFA)
modified for pediatric patients (maximal creatinine during illness). Policy
to start RRT was metabolic derangement and/or fluid overload and not
removal of inflammatory mediators in sepsis.
Results:
Among 105 children with MSS 9 (8.6%) presented ARF (SOFA score 3 + 4); 4
survivors and 5 non-survivors (3 died within 20 hours). Mortality of whole
cohort was 18.1%. ARF occurrence was associated with a higher mortality 55%
(p=0.009). 4 children were treated with continuous RRT for ARF as part of
multi-organ failure (mean duration 22 days) (table). 1 child electively
received continuous RRT because of congestive heart failure due to extreme
myocardial dysfunction.
Conclusion: ARF in children with MSS has a remarkable low incidence. The
occurrence of ARF is associated with a higher mortality. Continuous RRT is
an effective treatment modality for ARF and myocardial depression as part
of multi-organ failure in MSS.