Acute Renal Failure In Neonate Research Articles

Acute Renal Failure in Neonates:Clinical and Laboratory Profile

Acute Renal Failure in Neonates:Clinical and Laboratory Profile

Risk Factors Associated with Acute Renal Failure in Neonates of a neonatal Intensive Care Unit

Objetive: Determining the risk factors associated with acute renal failure in neonates.
 Materials and Methods: A case-control study was carried out, in 65 cases of acute renal failure and 65 without acute renal failure in the Intensive Care Unit Neonatals (NICU) of a hospital in Pachuca Hidalgo, Mexico. The variables studied; prematurity, low weight, type I respiratory distress syndrome, perinatal asphyxia, sepsis, necrotizing enterocolitis, administration of vancomycin, amikacin, amphotericin, cefotaxime and water restriction. The information was collected from the data of the clinical records and the analysis was carried out in the Epi-info software. The statistical analysis, it was performed using non-parametric tests such as Chi2 and Fisher's Exact Test.
 Results: Denote underweight with an OR 2, 95% CI. from 1.1 to 3.3 and <P 0.05 by Chi2 and Fisher's exact test. For; perinatal asphyxia with OR 2.1, 95% CI. from 1.3 to 3.4 and <P 0.05 through Chi2 and Fisher's exact test. For vancomycin administration OR 4.7, 95% CI. From 2.3 to 9.3 and <P 0.05 by Chi2 and Fisher's exact test. For water restriction OR 2, 95% CI. From 1.2 to 3.3 and <P 0.05 by Chi2 and Fisher's exact test.
 Conclusion: A significant association was found between acute renal failure with low weight, perinatal asphyxia, administration of vancomycin and water restriction.

Acute renal failure in newborns in the practice of a pediatrician of the future

Aims: The treatment of an acute renal failure has not received much research in Kazakhstan, whether focusing on adults or children. As a result, there is a lack of awareness about the condition of the field's knowledge as well as its challenges and prospects. Thus the goal is to identify and assess the studies that are currently accessible concerning the treatment of acute kidney failure in newborns or infants in the context of Kazakhstan experience. Study design: Literature review Methodology: MEDLINE, Cochrane Reviews, and Pedro were among the databases used to conduct the literature search. The conjunctions "AND" and "OR" were used with certain keywords. The articles' time range was restricted between 2018 and 2022 in order to only present the most recent facts. Papers discussing acute renal failure in infants only in Kazakhstan were included in the inclusion criteria. Results: Regarding the treatment of AKI in neonates in Kazakhstan, there are incredibly few available studies. The majority of trials involved individuals who were older. ESRD was more widely covered in conjunction with dialysis than AKI. Women are more prone to experience AKI turning into full-blown CKD. Conclusion: To learn more about the state of acute renal failure in neonates in Kazakhstan, more field study is required. The frequency and prevalence of placing new-borns on dialysis should be updated and made publicly accessible. It is important to emphasise the causes and risk factors of AKI in babies of Kazakh ancestry in order to comprehend current trends. Scientific Novelty: This is the first study that attempts to cover the status of pediatric acute renal failure management within Kazakhstan. It will serve as a starting point for prospective research on pediatric illnesses within the country, so as to understand where the health sector of Kazakhstan stands on the global stage.

Outcome of Acute Renal Failure in Neonates and Its Associating Factors

Objective:To identify various predisposing causes and immediate consequences in new-borns presenting with acute renal failure. Study design: The study design was case series. Place & duration:In the Pediatric department of Shifa International Hospital, Islamabad for one-year duration from September 2020 to August 2021. Material and Methods:A total of 1300 cases were assessed for acute renal failure (ARF)and 98 established cases of ARF being included in the research. The neonates (0-28 days old) who met the criteria for ARF, i.e., anuria/oliguria plus a serum creatinine level more than 1.5 mg/dl, were included in this research. The patient's relevant medical history, physical examination, and laboratory tests were recorded on a separate proforma after given informed permission for the procedure. Each patient's outcome was precisely documented. The statistical software for social sciences was used to examine the data (SPSS20.0). A p-value of less than < 0.05 was considered significant. Results:A total of 98 cases (7.5 percent) were studied, with 68 (69.4 percent) males and 30 (30.6 percent) females. The ratio of males to females was 1.6:1. According to the study results, the mean age was 9.85± 7.20 days and the mean weight was 2.54± 0.65 kg. The majority of the infants were delivered at a hospital (73.5 percent). The most prevalent ARF symptoms in our neonates were birth asphyxia (30.6%), sepsis (24.5%), respiratory distress syndrome (RDS) (11.2%), and dehydration (9.2%), bleeding in (4.1 percent) and meconium aspiration in 3(3.1 percent). CCF and neurogenic bladder were both present in two patients. In 4 individuals, obstructive uropathy was found, including 2 cases of urethral valve (PUV) blockage and 2 cases of pelvic ureteric junction obstruction (PUJO). Neonates with ARF had a 28.5 percent overall death rate (28 cases). Conclusion:When it comes to neonates in critical care, acute renal failure is a frequent concern to observe. More than one predisposing factor for acute renal failure was present in the majority of the patients. Preventing acute renal failure in infants may be accomplished by early identification of risk factors and prompt treatment of underlying diseases. Keywords:Renal failure, Sepsis, Birth asphyxia, Neonates

Perinatal asphyxia and acute renal failure in neonates: presentation and outcomes

Background: Perinatal asphyxia (PNA) is described by the world health organization as a "failure to begin and sustain breathing at delivery." Acute renal failure (ARF), a well-known consequence of birth asphyxia, has a poor immediate prognosis and can leave survivors with lasting renal impairment. The goal of this study was to find out how often ARF is in cases of PNA and how it relates to the severity of the Apgar score and the grading of hypoxic ischemic encephalopathy.Methods: This study was based on APGAR scores and a renal function evaluation done on day 3 of life on neonates with a gestational age of >34 weeks and signs of birth asphyxia.Results: According to the APGAR score, 46 percent of the 75 infants investigated had mild PNA, whereas 42% and 12% of the babies had moderate and severe PNA. ARF was discovered in 24% of PNA patients, with oliguric renal failure (ORF) in 42% and non-ORF (NORF) in 58%. Blood urea was elevated in all instances with ARF (100%) but only 8% of non-ARF patients. ARF was found in 100% of individuals with severe PNA, but only 28% of patients with mild PNA. ARF was not found in any of the individuals with mild PNA. Only 3 (4%) of asphyxiated babies had abnormal renal USG results.Conclusions: Our findings revealed a substantial link between PNA severity and ARF, with no ARF in mild PNA. The incidence of ARF and the stage of HIE were shown to have a linear association in this study. Only ORF instances resulted in death.

To determinate the degree or severity of renal impairment according to HIE stages in PNA patients

Introduction: Perinatal asphyxia is a major cause of acute renal failure in neonates. So it is essential to evaluate the renal function at an early stage to stabilize fluid and electrolyte balance which is of great importance to infants with hypoxic-ischemic encephalopathy. Yet, it is not quite easy to evaluate neonatal renal function accurately. Objective: To Determinate the Degree or Severity of Renal Impairment According To HIE Stages in PNA Patients. Materials and Methods: This cross-sectional study was carried out in the department of neonatology, Chattagram Ma-O-Shishu hospital from January 2016 to June 2016. All Perinatal asphyxia patients admitted in the department of neonatology, Chattagram Maa-Shishu O General Hospital fulfilling the inclusion criteria were included in the study. As the study was done in a single center and due to time constrain 180 cases were enrolled in this study. After taking informed written consent from legal attended a total of 150 asphyxiated and 30 non-asphyxiated newborns were selected by purposive sampling. Results: During the study period, there were total 197 eligible infants. Among them 154 were case and 43 were control. Among the cases 2 infants left against medical advice (LAMA), 1 infant died, and 1 was excluded due to lack of parental consent. Among the control 13 were excluded due to lack of consent. Finally 150 asphyxiated newborn were selected as case and 30 normal infants were included as control in the study. In this study, stage I, 50(60.2%) baby has normal RFI and 33 (39.8%) babies has abnormally high RFI. For stage II, 23 (43.4%) baby has normal RFI and 30 (56.6%) baby has abnormally high RFI and for stage III, only 5 (35.7%) baby has normal RFI and 9 (64.3%) baby has abnormally high RFI. Their P-value is 0.070, which is statistically not significant. The study also shows Mean ± SD of RFI value in stage I is 2.76 ± 0.62, for Stage II is 3.17 ± 0.67, and for stage III, is 3.17 ± 0.28 and “p” value 0.001 which is statistically highly significant. Conclusion: In conclusion, AKI represents a significant problem among asphyxiated neonates. All of the hyperechogenic kidney patients were also hyperuricemic, which supports the possible association between both features. In addition, uric acid itself might be the causative factor for failure in addition to hypoxic and ischemic insult. We recommend kidney functions, and abdominal ultrasonography to be done routinely in asphyxiated neonates to evaluate the possibility of acute kidney injury in them. FENa and RFI are useful parameters for assessing renal function and urinary β2M is a good biomarker for diagnosis and prognosis of acute tubular injury in term babies with perinatal asphyxia.

To Determinate the Degree or Severity of Renal Impairment According to HIE Stages in PNA Patients

Introduction: Perinatal asphyxia is a major cause of acute renal failure in neonates. So it is essential to evaluate renal function at an early stage to stabilize fluid and electrolyte balance which is of great importance to infants with hypoxic-ischemic encephalopathy. Yet, it is not quite easy to evaluate neonatal renal function accurately. Objective: To Determinate the Degree or Severity of Renal Impairment According to HIE Stages in PNA Patients. Materials and Methods: This cross sectional study was carried out in the department of neonatology, Chattagram Ma-O-Shishu hospital from January 2016 to June 2016. All Perinatal asphyxia patients admitted in the department of neonatology, Chattagram Maa-Shishu O General Hospital fulfilling the inclusion criteria were included in the study. As the study was done in a single center and due to time constrain 180 cases were enrolled in this study. After taking informed written consent from legal attended a total of 150 asphyxiated and 30 non-asphyxiated newborns were selected by purposive sampling. Results: During the study period, there were total 197 eligible infants. Among them 154 were case and 43 were control. Among the cases 2 infants left against medical advice (LAMA), 1 infant died, and 1 was excluded due to lack of parental consent. Among the control 13 were excluded due to lack of consent. Finally, 150 asphyxiated newborns were selected as case and 30 normal infants were included as control in the study. In this study, stage I, 50(60.2%) baby has normal RFI and 33 (39.8%) babies have abnormally high RFI. For stage II, 23 (43.4%) baby has normal RFI and 30 (56.6%) baby has abnormally high RFI and for stage III, only 5 (35.7%) baby has normal RFI and 9 (64.3%) baby has abnormally high RFI. There P value is 0.070, which is statistically not significant. The study also shows Mean ± SD of RFI value in stage I is 2.76 ± 0.62, for Stage II is 3.17 ± 0.67 and for stage III, is 3.17 ± 0.28 and “p” value 0.001 which is statistically highly significant. Conclusion: In conclusion, AKI represent a significant problem among asphyxiated neonates. All of the hyperechogenic kidney patients were also hyperuricemic, which supports the possible association between both features. In addition, uric acid itself might be the causative factor for failure in addition to hypoxic and ischemic insult. We recommend kidney functions, and abdominal ultrasonography to be done routinely in asphyxiated neonates to evaluate the possibility of acute kidney injury in them. FENa and RFI are useful parameters for assessing the renal function and urinary β2M is a good biomarker for diagnosis and prognosis of acute tubular injury in term babies with perinatal asphyxia.

Correlation of renal function tests with early onset neonatal sepsis.

Early onset neonatal sepsis is invariably very common and serious problem worldwide, especially it is one of the important etiological factor for deaths of neonates in Pakistan. Acute renal failure is frequently seen in neonates with sepsis. Objectives: The aim of present study was to determine the correlation of renal function tests (Blood Urea and creatinine) with early onset neonatal sepsis. Study Design: Descriptive study. Setting: Department of Paediatric Medicine Sir Ganga Ram hospital, Lahore. Period: Six months from 20th March to 20th September 2018. Material & Methods: Total 300 cases of neonatal sepsis with acute renal failure were included in this study after taking informed consent from the parents. Cases selection was done with help of a predefined inclusion and exclusion criteria. Daily blood urea and serum creatinine were calculated from birth to first 7 days of life. If any of blood urea or serum creatinine was deranged, the neonate was labelled as having acute renal failure. Data was entered and analysed using SPSS software version 21. Results: Mean age of all cases was 2.82±1.56 days. The minimum and maximum age limits of the neonates were 1 and 7 days respectively. Gender distribution of neonate showed that 57% of the neonates were male and 43% were females. At the 2nd day of life, mean serum creatinine level was 1.12±0.39, at 3rd day 1.19±0.51, at 4th day 1.41±0.38, at 5th day 1.33±0.39, at 6th day 1.19±0.39, and at 7th day mean serum creatinine level was 1.09±0.31 respectively. At 2nd day of birth mean blood urea was 54.82±34.77, at 3rd day59.50±28.22 at 4th day 74.94±30.37, at 5th day 67.09±26.94, at 6th day 56.09±25.76, at 7th day mean blood urea level was 47.66±22.47 respectively. Frequency of acute renal failure was observed in 28.3% of the neonates while the remaining 71.7% of neonates did not suffer from acute renal failure. Conclusion: Early onset neonatal sepsis contributes significantly to development of acute renal failure in neonates.

Predictive Factors for Acute Renal Failure in Neonates with Septicemia

Objectives: Septicemia is an important cause of acute kidney injury (AKI) in neonates admitted to neonatal intensive care units. The aim of this study was to identify the predictive factors for AKI in neonates with culture-proven septicemia. Methods: Medical records of 138 newborns with septicemia were evaluated in 2 groups with (n, 65) and without (n, 73) AKI. Results: The mean age at diagnosis of AKI was 11.31 ± 9.92 days. AKI was more common in neonates with lower gestational age, birth weight, age, blood pressure, platelet count, and serum pH at admission. Moreover, AKI was associated with an increased incidence of intubation at birth, inotrope treatment, shock, disseminated intravascular coagulation (DIC), mechanical ventilation, and morality. Gestational age, initial serum pH, and DIC were the only independent predictors of AKI in the multivariate analysis. In addition, serum pH at admission was the most accurate laboratory marker for the prediction of AKI with 83% sensitivity and 60% specificity. Conclusions: Monitoring of renal function is highly recommended in low-birth-weight infants with severe septicemia.

Continuous renal replacement therapy of acute renal failure in neonate

Acute renal failure (ARF) is the common critical disease caused by various factors in neonates, its clinical manifestation is the sharp decline in renal function, in a short period of time, the serum creatinine is increased and urine volume decreases.However, recently, with the progress of blood purification technology, continuous renal replacement therapy (CRRT) has been used from ARF in elderly children to the newborn.In this paper, the risk factors of neonatal ARF, diagnostic criteria, the relevant questions of CRRT treatment were reviewed. Key words: Renal failure; Infant, newborn; Continuous renal replacement therapy

Renal outcome in children born preterm with neonatal acute renal failure: IRENEO-a prospective controlled study.

Acute kidney injury (AKI) is a severe complication of prematurity, with currently unknown consequences for renal function in childhood. The objective of this study was to search for signs of reduced nephron number in children aged 3-10years who had been born preterm with neonatal AKI and compare this group to control children. IRENEO was a prospective, controlled study conducted in 2013 in Nantes University Hospital. Children who were born at less than 33weeks gestational age (GA) and included in the LIFT cohort were eligible for entry. Twenty-five children with AKI (AKI-C) and 49 no-AKI children were matched on a propensity score of neonatal AKI and age. AKI was defined as a serum creatinine level higher than critical values: 1.6mg/dl (GA 24-27 weeks), 1.1mg/dl (28-29) and 1mg/dl (GA 30-32). Renal function was evaluated during childhood. Mean age of the children at the time of the study was 6.6years. No difference in microalbuminuria, estimated glomerular filtration rate (GFR) or pulse wave velocity was observed between the two groups. Renal volume was lower in the AKI-C group (57 vs. 68; p = 0.04). In the entire cohort, 10.8% had a microalbuminuria, and 23% had a diminished GFR (median 79ml/min/1.73m2). The GFR was lower in children with very low birth weight of <1000g (99 vs. 107ml/min/1.73m2; p = 0.04). In children born preterm, neonatal AKI does not seem to influence renal function. However, independent ofAKI, a large proportion of very preterm infants, especially those with very low birth weight, presented with signs of nephron reduction, thus requiring follow-up with a nephrologist.

Acute Renal Failure in Neonates with Perinatal Asphyxia and its Correlation with HIE Staging: A Prospective Case Control Study

Acute Renal Failure in Neonates with Perinatal Asphyxia and its Correlation with HIE Staging: A Prospective Case Control Study

Renal failure index and assessment of renal function in asphyxiated newborns

Objective: To assess the renal failure index (RFI) in asphyxiated neonates in relation to other clinical and laboratory findings among those with acute renal failure, whether prerenal or intrinsic renal failure. Background: Asphyxia is an important cause of morbidity and mortality among neonates. It leads to multiorgan dysfunction and redistribution of cardiac output to maintain cerebral, cardiac and adrenal perfusion while potentially compromising renal, gastrointestinal and skin perfusion. Thus, acute renal failure is recognized as a complication of birth asphyxia. Materials and Methods: This case–control study included 80 neonates divided into two groups: the patient group (40 babies with perinatal asphyxia) and the control group (40 normal babies). In all patients, hypoxic ischemic encephalopathy staging (Sarnat and Sarnat) was performed. Blood and urinary parameters for renal function were assessed in all newborns, and fractional excretion of sodium (FENa) and the RFI were also calculated. The results obtained were analyzed and compared within subgroups using the computer program statistical package for social science, version 16. Results: Acute renal failure was noted in 19 patients in the patient group (47.5%): 16 of them (40%) had prerenal failure and three had intrinsic renal failure (7.5%). FENa and the RFI were found to be the most useful in evaluating babies with renal failure, as these derived renal indices were more reliable than individual parameters. FENa and RFI increased with increasing hypoxic ischemic encephalopathy staging. Conclusion: Perinatal asphyxia is an important cause of neonatal acute renal failure, which is predominantly prerenal failure. FENa and RFI are useful parameters for assessing the renal function in these neonates and can be used to differentiate prerenal failure from intrinsic renal failure, and thus helps in proper management.

Acute renal failure in critically ill newborns increases the risk of death: a prospective observational study from India

Objective: To determine the incidence and risk factors of acute renal failure (ARF) in hospitalized critically ill neonates and analyze outcome of all neonates with renal failure in relation to risk factors. Material & methods: In this prospective observational study 815 infants were enrolled. Renal profile (blood urea and serum creatinine) was done after 12 h of life (or at the time of admission for outborn babies) and then every 12 hourly. Daily 24 h urine output was evaluated. Results: Incidence of renal failure in critically ill neonates was 10.67%. Out of 87 ARF neonates 52 (60%) expired. Mortality in the renal failure group was significantly higher in comparison to control group (p < 0.01). Non-oliguric renal failure was more common than oliguric renal failure, but mortality in the oliguric renal failure group was more. Neonatal sepsis was the most common cause of ARF. Eight neonates underwent peritoneal dialysis (PD) out of which there were seven neonatal deaths. Conclusion: Prognosis of neonates with ARF requiring PD was very poor. It can thus be concluded that the health care personal should do rapid diagnosis of ARF in neonates with potential risk factors and also goal at an early and effective treatment of these risk factors in neonates with ARF.

Acute renalfailure in the newborns hospitalized at the Intensive Care Unit, University clinical centre Tuzla

Introduction: Reasons for acute renal failure in hospitalized infants were sepsis, hypovolemia, asphyxia, respiratory distress syndrome, surgical interventions and congenital heart defects. The aim of this study was to determine the frequency and main etiologies, and early outcome of neonatal acute renal failure. Materials and Methods: At Intensive Care Unit, Clinical Center Tuzla, from 15. 01. 2013 to 15. 01. 2015 in 21 newborn was diagnosed renal failure, based on the amount of excreted urine and serum creatinine. Results: The prevalence of renal failure was 6.84%, with a higher incidence of female. 33.3% of infants were term neonates. Oliguria was diagnosed in 71.4% of newborns. Sepsis was the most common predisposing factor for the development of renal failure, associated with high mortality. Other causes of renal failure were perinatal hypoxia, RDS, surgical interventions and congenital heart defects. There was a positive correlation between the gestational age of the newborn and serum creatinine. Discussion: Early prevention of risk factors with rapid diagnosis and effective treatment, can affect further outcome of acute renal failure in infants.

Experience with Early Enteral Feeding in a Patient with Venoarterial Extracorporeal Membrane Oxygenation

The study deals with the pathogenesis and early diagnosis of renal dysfunction in low and extremely low birth weight (ELBW) premature neonates. Objective: to study the specific features of the mechanisms responsible for the development of acute renal failure (ARF) in low and ELBW neonates and to use an analysis of oxygen status parameters as a method for early diagnosis of neonatal ARF. Subjects and methods. The study included 172 neonatal infants with a birth body weight of 800 to 1500 g. The values of blood gas composition and base-acid balance, and oxygen status were daily studied in all the children, by analyzing all the indices reflecting tissue hypoxia. Results. Analysis of oxygen status parameters in relation to a baby&#8217;s body weight revealed no considerable differences. The development of renal dysfunction and ARF in low and ELBW neonates was demonstrated to be most frequently caused by the progression of respiratory failure and tissue hypoxia, which suggests secondary renal lesion in the pattern of multiple organ dysfunction. It was ascertained that edema had a direct correlation with a physiological shunt fraction and oxygenation index and a moderate inverse correlation with blood oxygen tension and respiration index. In addition, an inverse correlation was found between the serum concentration of lactate and the daily volume of diuresis. The rate of hourly diuresis had a direct correlation with respiratory index and an inverse correlation with oxygenation index. Conclusion. Dysfunction of the kidneys and acute renal failure in neonatal infants in the pattern of multiple organ syndrome are secondary and closely related to the progres&#8211; sion of respiratory failure, as suggested by the oxygen status parameters that may be used for the prediction and early diagnosis or Key words: acute renal failure, renal dysfunction, neonaQtal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction. neonates. Key words: acute renal failure, renal dysfunction, neonatal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction.

Treatment of Acute Renal Failure in Neonate

Treatment of Acute Renal Failure in Neonate

Evaluating and managing neonatal acute renal failure in a resource-poor setting

Acute renal failure (ARF) is encountered in neonatal care where it may be associated with significant morbidities. Pre-renal failure, which is due to impaired renal tissue perfusion, is the commonest type of ARF. It is amenable to treatment with excellent prognosis following prompt diagnosis and timely institution of appropriate intervention. Unfortunately, ARF in the newborn is usually asymptomatic and it is only suspected when a newborn infant has not been observed to pass urine over several hours or when serum Creatinine is observed to be elevated or rising. In resource-poor settings, it is often difficult to conduct detailed evaluation of suspected cases of newborn ARF due to lack of appropriate equipments and infrastructure. Similarly, therapeutic facilities are sparse and there is heavy reliance on conservative management of cases. Such difficulties encountered in the evaluation and management of newborns with ARF in most parts of the developing world, like Nigeria, where diagnostic and therapeutic facilities are limited are highlighted.

Acute renal failure in neonates

Acute renal failure (ARF) is a common condition seen in neonatal intensive care units. It is broadly classified into prerenal, intrinsic renal and post renal failure. There is no consensus on the definition of neonatal ARF. Of utmost importance is to differentiate prerenal from intrinsic renal failure. The most common causes of neonatal ARF are hypovolemia, hypotension and, hypoxia. Among several indices that are available for differentiating prerenal failure from intrinsic renal failure, fractional excretion of sodium is the preferred index. Diagnostic fluid challenge with or without frusemide is a bed side method for differentiating prerenal failure from intrinsic renal failure. Babies with ARF have to be monitored for several metabolic derangements like hyponatremia, hyperkalemia, hypocalcemia, and acidosis and have to be managed accordingly. Fluid balance should be precise in order to avoid fluid overload. It is difficult to provide adequate calories due to fluid restriction. Dialysis has to be instituted to preempt complications. Peritoneal dialysis is the easiest and safest modality. These babies need long term follow up as they are prone for long term complications.

Novel HGPRT 293 A&gt;G point mutation presenting as neonatal acute renal failure

We report on a rare case of hypoxanthine guanine phosphoribosyl transferase (HGPRT) deficiency that presented in the newborn period with acute renal failure (ARF). The clinical diagnosis was made on the basis of non-oliguric ARF and evidence of crystal nephropathy on renal biopsy. HGPRT deficiency was eventually confirmed by enzymatic and genetic testing, showing a novel point mutation, 293 A>G. Immediate treatment consisted of peritoneal dialysis with, initially, lactate- then bicarbonate-buffered 1.36% glucose solution together with oral administration of allopurinol. Follow-up after more than 4 years continued to show hyper-echogenic kidneys with almost normal renal glomerular function. There continues to be no neurobehavioural abnormalities.