Acute Renal Failure in Oncologic Pediatric Patients

Between March 2014 and December 2016 eleven patients, (6 males, 5 females) with ages between less than 1 month (1),one children of 3 years old (yo) and 9 adolescents (10 to 18 yo); were admitted in the PICU with criteria of acute renal failure (ARF) and subsequent use of renal replacement therapy (RRT).
The causes of ARF were sepsis (7), tumoral lysis (1), bilateral nephrectomy (1), tumor compression (1) and chemotherapy (1).
The RRT was initiated less than 24 hours of admission in 6 patients and more than 24 hours (96 hours to 120 hours) in 5 patients. It was considered fluid overload when fluid intake-fluid output X-Weigh(kg) X 100 were > 10% in 24 hours.
All patients, but one underwent RRT by hemodialysis. The neonate used peritoneal dialysis. The types of neoplasia were: hemangioma (1), Leukemia (2), Linfoma (3), Osteosarcoma (1), rhabdomyosarcoma (1), Wills´s tumor (1) and ovarian tumor (1).
The overall mortality rate was 18% (2) and one patient developed a chronic renal disease after discharge. The average of length of stay (LOS) in PICU was 27,5 days
Our data showed that 54% o the patients (6) had liquid overload just before the RRT and in that group, the mortality rate was significantly higher (33%) when it was compared with the group with ARF (5) without liquid overload, which the mortality rate was zero. From those 6 patients,2 underwent RRT in the first 24 hours of admission and 4 after 24 hours.
Although the number of patients was small, the results highlight the worse outcome in patients with liquid overload, which indicates the importance of early recognition and the prompt beginning of the RRT in acute renal failure in oncologic pediatrics patients.Further studies are necessary in order to validate the results.