| Abstract|| |
Case records of patients aged 13 years or below with chronic renal failure (CRF), seen during the last 10 years at the King Hussein Medical Center, Amman, Jordan were reviewed. There were 46 patients with CRF, (25 males and 21 females), aged 1/2 to 13 years. Chronic pyelonephritis was the major cause of CRF seen in 23 cases (50%), followed by glomerulonephritis in eight (17.4%), congenital hypodysplasia in six (13%), hereditary nephritis in five (10.9%) and unknown etiology in four (8.7%). Of the study patients, 17.3% were below the age of five years at first presentation. Twenty one patients progressed to end-stage renal disease and among them chronic glomerulonephritis was the most common primary renal disease. The higher incidence of chronic pyelonephritis causing CRF in our series in comparison to 23.9% incidence reported in the developed countries shows that our infants and young children probably are not investigated early enough nor do they receive adequate treatment at the time of their first urinary tract infection. Prevention of renal failure, availability of replacement therapy, and extension of treatment opportunities to more children are the main problems concerning CRF in children in our country.
Keywords: Chronic renal failure, Children, End-stage renal disease, Jordan.
|How to cite this article:|
El Aun M, Hazza I, Qudah E, Najada AH, Khairi Y. Causes of Chronic Renal Failure in Children in a Single Hospital in Jordan: A 10 Years Retrospective Study. Saudi J Kidney Dis Transpl 1995;6:290-3
|How to cite this URL:|
El Aun M, Hazza I, Qudah E, Najada AH, Khairi Y. Causes of Chronic Renal Failure in Children in a Single Hospital in Jordan: A 10 Years Retrospective Study. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2013 May 18];6:290-3. Available from: http://www.sjkdt.org/text.asp?1995/6/3/290/40664
| Introduction|| |
Many renal diseases in children can be prevented or treated medically  . While chronic renal failure (CRF) is not common in childhood, it does impose a heavy social and economic burden. The incidence and etiology of CRF in children vary according to age of the child, ethnic background and in different parts of the world and reflects the changing nature of pediatric service. The reported annual incidence of new cases of renal insufficiency in children requiring long-term dialysis ranges from 1.5 to 6 per million total population , . In this study, we have attempted to evaluate the causes of CRF among children at one hospital in Jordan and compare our findings with those reported from other parts of the world.
| Patients and Methods|| |
Case records of patients with CRF below the age of 14 years, seen at King Hussein Medical Center, Amman, Jordan during the last 10 years were reviewed. There were 46 patients, (25 males, 21 females) aged 1/2 to 13 years (mean 7.8 years). For the purpose of this study, CRF was defined as a persistent elevation of serum creatinine above the normal for the age of the patient  . End-stage renal disease (ESRD) was defined as the stage at which dialysis therapy or renal transplant is indicated  .
| Results|| |
Of the 46 patients with CRF, eight (17.4%) were below the age of five years, 18 (39.1%) were between 5-9 years of age and 20 (43.5%) were between 10-13 years at the time of first presentation [Figure - 1]. Nearly half of these patients (47.8%) were referred from other centers in Jordan for further management. Chronic pyelonephritis was the major cause of CRF among our study patients seen in 23 cases (50%). All these patients had a previous history of frequent episodes of urinary tract infection (UTI) before presentation with CRF. Glomerulonephritis occurred in eight (17.4%) of the cases, congenital hypodysplasia of the kidneys, diagnosed by ultrasound and kidney biopsy, was seen in six (13%), hereditary nephritis was seen in five (10.9%) and in four others (8.7%) no diagnosis could be established [Figure - 2]. Twenty one of these patients (45.6%) developed ESRD after a mean period of 82 months, and among them chronic glomerulonephritis was the major cause seen in seven patients (33.3%), followed by congenital hypodysplasia in five (23.8%), chronic pyelonephritis in four (19.1%) and miscellaneous causes in five others (23.8%). A total of 17 patients with CRF (36.9%) and 20 of the 21 patients with ESRD (95.2%) had growth retardation defined as body height corresponding to two standard deviations or more below the reference mean for sex and chronologic age (5).When last seen, four (19%) of our patients with ESRD were on continuous ambulatory peritoneal dialysis (CAPD), and three (14.3%) were on regular hemodialysis. Three others (14.3%) underwent renal transplantation of whom, one was transplanted in Jordan while two others were transplanted abroad.
Twenty four of the 46 study patients died during follow-up with an overall mortality rate of 52.2%. The cause of death was as follows: cardiac in 16, sepsis in two and unclassified in six patients.
| Discussion|| |
The most striking finding in our study is the high incidence of chronic pyelonephritis among children with CRF (50% of the cases), a frequency twice that observed in the developed countries (23.9%)  . Data obtained from the European Dialysis and Transplant (EDTA) Registry shows that the most frequent cause of CRF is glomerulonephritis (27.9%), followed by pyelonephritis (23.9%)  . Chronic glomerulonephritis has been reported as a cause of CRF in 38% of children in developing countries  , a frequency higher than that observed in our study (17%). However, our results are similar to reports from some other Middle Eastern countries , as depicted in [Table - 1].
The distribution of affected children according to age is also important. In our study, 17.3% of our children were below three years at the time of their presentation. This is in contrast to reports from the EDTA registry which shows that less than 10% of children were below three years of age (8). Thus, the number of younger children was higher in our study.
It is reported that about 1/3 of children with CRF receiving conservative treatment are below the third centile for height  . In our study, 36% of the patients with CRF and more than 95% of those with ESRD were below the third centile for height.
Reports from the EDTA registry show that glomerulonephritis (31%) is the main cause of primary renal disease leading to ESRD, followed by pyelonephritis (22%), hereditary nephritis (16%) and renal hypodysplasia (12%)  . Also, reports from the United States show that glomerulonephritis is the major cause of ESRD among children (37.6%) followed by hereditary nephritis (9.1%)  . Among our study patients with ESRD also, glomerulonephritis was the most frequent cause (33.3%) followed by congenital hypodysplasia (23.8%) and chronic pyelonephritis (19%).
The mortality rate among our study patients with ESRD was 52.2% in comparison with 7% observed in the United States  . The reasons for this high mortality could be related to delay in commencement of renal replacement therapy, inadequate facilities for the care of children with ESRD and/or poor compliance to therapy. These factors are common to all developing countries.
This study shows that pyelonephritis is a major cause of CRF among our pediatric patients. This reflects that our infants and younger children do not undergo early and adequate investigations or receive proper treatment at the time of their first episode of UTI. Awareness should be built up about the necessity of investigating children with UTI properly which will in turn, help in making early diagnosis and instituting prompt treatment of preventable causes of CRF.
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Department of Pediatrics, P.O. Box 960955, Amman
[Figure - 1], [Figure - 2]
[Table - 1]