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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 4  |  Page : 418-419
Childhood Chronic Renal Failure in Qatar


Department of Pediatrics, Hamad General Hospital, Doha, Qatar

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How to cite this article:
Akl KF. Childhood Chronic Renal Failure in Qatar. Saudi J Kidney Dis Transpl 1995;6:418-9

How to cite this URL:
Akl KF. Childhood Chronic Renal Failure in Qatar. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Aug 9];6:418-9. Available from: http://www.sjkdt.org/text.asp?1995/6/4/418/40562
To the Editor:

The exact incidence of end-stage renal disease (ESRD) in Qatar is not known for two main reasons: travel abroad for medical treatment and continual influx and efflux of people into the country. The reported prevalence of chronic renal failure (CRF) among children in Saudi Arabia is 20.4 cases per million children [1] and a similar figure could be expected in Qatar as well. Knowledge about the incidence as well as etiological spectrum of CRF in children in Qatar is important considering the fact that about a quarter of Qatar's population of 400,000 comprises of children below the age of 13 years. Also, the number of infants and children with ESRD in Qatar seems to be increasing in recent years. This is probably due to several factors, including an actual rise in number, increasing acceptance into therapy, and return to Qatar of some patients who were treated abroad.

Our study included fifty-nine children with varying levels of chronic renal failure (CRF) who were seen by the renal service at Hamad General Hospital, Doha, Qatar between 1982 and 1994. All patients were seen and followed by the author. Newborns that died due to Potter's syndrome and children that left the country during the study period were excluded from the study.

For the purpose of this study, CRF was defined as serum creatinine level above 180 µmol/L (2mg/dl) for at least six months. End-stage renal disease was defined as CRF requiring dialysis or renal transplantation.

The diagnoses and status of the 59 study children with varying levels of CRF are shown in [Table 1]. There were 32 Qataris and 27 Non-Qataris in the study with their age ranging between seven months and 13 years. When patients were classified according to age at the time of presentation, there were 22 children (37.3%) below the age of one year (18 males, 4 females), 11 (18.6%) between 1 and 5 years (6 males, 5 females) and 26 (44.1%) above five years of age (11 males, 15 females). The overall follow-up period was 12 years. Congenital malformations of the urinary tract consti­tuted the commonest cause of CRF seen in 29 patients (49%) followed by glomerulo­pathies in nine (15%) and renal hypodysplasia seen in six patients (10%). The remaining fifteen patients (26%) had miscellaneous causes of CRF. These results are in agree­ment with other reports from Saudi Arabia [2] , Europe [3] , and the United States [4] . Of the congenital malformations, posterior urethral valve constituted the commonest lesion seen in 19 of 29 patients (65.5%). Prenatal ultrasonography makes it possible to detect obstructive uropathy at an early age, thereby enabling early management which should result in preventing or at least delaying the onset of ESRD in these patients to some extent as well as permitting children to achieve better growth and development. However, Jee et al estimate that antenatal diagnosis of posterior urethral valve may be beneficial in less than 20% of the cases [5] . A total of 16 study patients (27.1%) developed ESRD during follow-up. Glomerulopathies were the leading cause of renal disease in this group of patients occurring in four of them (25%) followed by malformations of the urinary tract, oxalosis and renal hypo­dysplasia in three patients each (18.7%). Onset of ESRD below the age of five years was more commonly associated with malformations of the urinary tract and above five years with glomerulopathies. Similar results have been reported by other workers [2],[6],[7],[8],[9] . Delayed patient referral, in addition to poor patient compliance, made prevention of CRF difficult and possibly contributed to the deterioration of these patients. When last seen, six of the 16 patients with ESRD (37.5%) were on continuous ambulatory peritoneal dialysis, four (25%) were on hemodialysis while four others (25%) underwent successful renal transplantation abroad.

In conclusion, with improved medical care, more CRF patients are expected to survive, and the number reaching ESRD is bound to increase. Some of the common causes of CRF and ESRD in Qatar such as congenital malformations can be treated and the onset of CRF prevented or delayed. Early detection and proper management of such patients will result in stopping or delaying the onset of renal failure.

 
   References Top

1.Aldrees A, Kurpad R, Al-Sabban EA, Ikram M,Abu-Aisha H. Chronic renal failure in children in 36 Saudi Arabian Hospital. Saudi Kidney Dis Transplant Bull 1991;2:134-8.  Back to cited text no. 1    
2.Mattoo TK, Al-Mohalhal S, Al-Sowailem A, Al-Harbi M, Mahmood MA. Chronic renal failure in children in Saudi Arabia. Ann Saudi Med 1990;10:496-9.  Back to cited text no. 2    
3.Donckerwolcke RA, Broyer M, Brunner FP, et al. Combined report on regular dialysis and transplantation of children in Europe XI, Proc EDTA 1981;19:61-91.   Back to cited text no. 3    
4.Zilleruelo G, Andia J, Gorman HM, Strauss J. Chronic renal failure in children: analysis of main causes and deterioration rate in 81 children. Int J Pediatr Nephrol 1980;l:30-3.  Back to cited text no. 4    
5.Jee LD, Rickwood AM, Turnock RR. Posterior urethral valves. Does prenatal diagnosis influence prognosis? Br J Urol 1993;72(5):830-3.  Back to cited text no. 5    
6.Potter DE, Holliday MA, Piel CF, Feduska NJ,Belzer FO, Salvatierra O Jr. Treatment of endstage renal disease in children: a 15 years experience. Kidney Int 1980;18:103-9.  Back to cited text no. 6  [PUBMED]  
7.Habib R, Broyer M, Bennaiz H. Chronic renal failure in children. Causes, rate of deterioration and survival data. Nephron 1973;11:209-20.  Back to cited text no. 7    
8.Broyer M. Frequence et causes de l'insuffisancee renale chez l'enfant in Nephrologie Pediatrique, Paris, Flammarion Medicine Sciences 1983;425-30.  Back to cited text no. 8    
9.Champion G, Nivet H. End-stage renal insufficiency in children less than 4 months old. Survey of the French Pediatric Nephrology Club. Arch F Pediatr 1986;43:481-6.  Back to cited text no. 9    

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Correspondence Address:
Kamal Farid Akl
Consultant Pediatric Nephrologist, P.O. Box 3004, Amman 11181, Jordan

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PMID: 18583752

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