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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD Table of Contents   
Year : 2004  |  Volume : 15  |  Issue : 1  |  Page : 75-78
Chronic Renal Failure among Children in Riyadh Military Hospital, Riyadh, Saudi Arabia


1 Department of Pediatrics, Riyadh Military Hospital, Riyadh, Saudi Arabia
2 Research Center, Riyadh Military Hospital, Riyadh, Saudi Arabia

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   Abstract 

In a retrospective survey, 75 children with chronic renal failure (CRF) referred to our renal unit during 1989-2002 were studied. Their ages ranged from 10 days to 14 years (male to female ratio 1.7:1) and 64% of the cases were under one year of age. The mean annual incidence of CRF was 7.14%. All the patients had irreversible levels for creatinine corresponding approximately to a glomerular filtration rate less than 50 ml/min/1.73 m 2 . The main etiological groups of primary renal disease were malformation of the urinary tract (45.3%), renal hypoplasia/dysplasia (18.7%), hereditary disorders (9.3%), glomerulopathies (6.7%), nephrotic syndrome (5.3%), while urinary system anomalies only made up 2.5% of the cases. The remaining (12%) had CRF of unknown etiology. Twenty-eight patients were treated for CRF of whom 13 patients were started on ambulatory peritoneal dialysis and five, on hemodialysis. Seven patients have undergone transplantation and three died.

Keywords: Chronic renal failure, Military Hospitals in Saudi Arabia, Children, Etiology, Incidence, Dialysis.

How to cite this article:
Al-Ghwery S, Al-Asmari A. Chronic Renal Failure among Children in Riyadh Military Hospital, Riyadh, Saudi Arabia. Saudi J Kidney Dis Transpl 2004;15:75-8

How to cite this URL:
Al-Ghwery S, Al-Asmari A. Chronic Renal Failure among Children in Riyadh Military Hospital, Riyadh, Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2004 [cited 2019 Sep 20];15:75-8. Available from: http://www.sjkdt.org/text.asp?2004/15/1/75/33708

   Introduction Top


The treatment of chronic renal failure (CRF) with diet, medications, dialysis and renal transplantation offers improved survival and quality of life for children as well as adults.[1] The epidemiological data of renal disease in children are very important in order to plan for their special medical requirements, including dialysis and renal transplant. The incidence of CRF, its causes and results of treatment have been researched and discussed extensively in many countries.[2],[3],[4],[5],[6],[7],[8],[9],[10] However, only frag­mented information is available from Saudi Arabia. [1],[12],[13] The Riyadh Military Hospital (RMH) is one of the main referral centers in Riyadh city. Thus, most of the cases of CRF are referred to this hospital for further manage­ment from different military hospitals distri­buted in different regions of Saudi Arabia. The purpose of this study was to determine the incidence of CRF and to identify its common causes.


   Patients and Methods Top


Data were collected from 75 children (aged up to 14 years) with CRF who were admitted to the Nephrology Unit in the department of pediatrics at RMH, including those seen in the out patient department. The study period extended for 14 years (1989 to 2002). The RMH is a referral center that receives 70% of patients referred from different military hospitals distributed in various regions of Saudi Arabia. The RMH has all the modern facilities for the diagnosis of various renal disorders. About 30% of patients in this report were born in RMH and they were brought to our attention either by referral for postnatal management or antenatal counseling. Neonates that died after birth from renal impairment were excluded.

Review of the patient information data included age, sex, medical history (including urinary tract infection, edema, and hematuria), family history (including renal disease, renal stones, and consanguinity), physical exami­nation, radiographic studies, and renal biopsy findings. Standard biochemical (serum and urine) and radiological investigations were performed. The diagnosis of CRF was based on clinical, laboratory, and radiological find­ings. All patients had an irreversible serum creatinine level [14] or a glomerular filtration rate (GFR) below 50ml/min/1.73 m 2 .


   Results Top


A total of 75 children with CRF, 47 boys and 28 girls (male to female ratio (1.7:1) were admitted to our center during this period 1989 to 2002 [Table - 1]. The patients were up to 14 years of age and 64% were less than one year old [Table - 2]. The mean annual incidence of CRF was 7.14% and the total number of patients varied in each with an increasing tendency during 1995 to 2001. Three children died from CRF, 13 patients were on peritoneal dialysis, five on hemodialysis and seven had undergone renal transplantation. The primary causes of renal disease in these patients are presented in [Table - 3]. Malformation was the dominant cause and included urinary tract anomalies (45.3%), hereditary disorders (9.3%) and urinary system anomalies (2.5%). The second most common cause was renal hypo/ dysplasia (18.7%), while glomerulopathies and the nephrotic syndrome were observed in 6.7% and 5.35% of patients respectively.


   Discussion Top


The incidence of CRF among children seen in different military hospitals of Saudi Arabia is not well known. It is very difficult to estimate the exact number of cases of CRF, because many patients remain asymptomatic, and the disease sometimes is detected by chance. [13] The predominance of male over female patients [Table - 2] in this study is in agreement with other studies. [1],[13] [Table - 3] summarizes the primary causes of CRF in our unit, compared to some national [2],[8] and international reports [Table - 4]. [2],[7],[15] Malfor­mation of the urinary tract constitutes the prominent group in our patients 45%. This figure is slightly higher than that of the other two national reports and is markedly higher than the international studies [Table - 4]. This may be attributed to delay in the diagnosis and treatment; failure to recognize the symptoms and seriousness of urinary tract infections remain a matter of major concern in this country. Urine culture should be performed routinely in infants and small children with fever of unknown origin. Genetic factors may relate to high incidence of consanguineous marriage. [1] The above findings could be ex­plained by the fact that renal disorders among children in Saudi Arabia should be taken seriously and dealt with through programmed health services at well baby clinics, at school and by careful investigation of children with urinary tract infection. Furthermore, poor communication among staff in different specialties also adds to the difficulties of counseling the parents both antenatally and postnatally.

Hypo/dysplasia was the primary renal disease in 18.7% of CRF patients, which is slightly higher than earlier Saudi studies and is significantly high as compared to a Swedish report [15]. Hereditary renal disorders caused 9.3% of the CRF cases in our study. It is less than the previous national and international reports [Table - 4]. The incidence of glomerulo­pathies in this study was very low when compared with the other national and inter­national reports [Table - 4]. This may be due to strict diagnostic criteria applied to this group, as all cases included were biopsy proven. Only three children died, while seven were transplanted and 23 were on dialysis. We believe that better management of end-stage renal failure (ESRF) is required since it will lead to better quality of life and longer survival of patients. Thus, availability of better facilities and expertise can save many children from development of progressive renal disease and irreversible renal damage.


   Acknowledgment Top


We thank Mr. Duwehi Al-Shamari for his assistance in this work.

 
   References Top

1.Mattoo TK, AL Mohalhal S, Al Swailem AM, 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. 1    
2.Broyer M. Incidence and etiology of ESRD in children. In: End-stage renal disease in children. Fin RN, Grustin AB (eds). Philadelphia, WB Saunders. 1984;9-16.  Back to cited text no. 2    
3.Deleau J, Andre JL, Briancon S, Musse JP. Chronic renal failure in children: an epidemiological survey in Lorraine (France) 1975-1990; Pediatr Nephrol 1994;8:472-6.  Back to cited text no. 3    
4.Esbjorner E, Aronson S, Berg U, Jodal U, Linne T. Children with chronic renal failure in Sweden 1978-1985. Pediatr Nephrol 1990;4:249-52.  Back to cited text no. 4    
5.Habib R, Broyer M, Benmaiz H. Chronic renal failure in children. Causes, rate of deterioration and survival data. Nephron 1973;11:209-20.  Back to cited text no. 5    
6.Pistor K, Olbing H, Scharer K. Children with chronic renal failure in the Federal Republic of Germany. I. Epidemiology, modes of treat­ment, survival. Clin Nephrol 1985;23:272-7.  Back to cited text no. 6    
7.Pistor K, Scharer K, Olbing H, Tamminen­Mobius T. Children with chronic renal failure in the Federal Republic of Germany: II. primary renal diseases, age and intervals from early renal failure to renal death. Clin Nephrol 1985;23:278-84  Back to cited text no. 7    
8.Potter DE, Holliday MA, Piel CF, Feduska NJ, Belzer FO, Salvatierra O Jr. Treatment of end-stage renal disease in children: a 15­Years experience. Kidney Int 1980;18:103-9.  Back to cited text no. 8    
9.Hamed RM. The spectrum of chronic renal failure among Jordanian children. J Nephrol 2002;15(2):130-5.  Back to cited text no. 9    
10.Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58:259-63.  Back to cited text no. 10    
11.Watson AR, Readett D, Nelson CS, et al. Dilemmas associated with antenatally detected urinary tract abnormalities. Arch Dis Child 1988;63:719-22.  Back to cited text no. 11    
12.Abdurrahman MB, EI Edrissy AP. Childhood renal disorders in Saudi Arabia. Pediatr Nephrol 1988;2(3):368-72.  Back to cited text no. 12    
13.AL Harbi N. Chronic renal failure in children in Asir region of Saudi Arabia. Saudi J Kidney Dis Transplant 1997;8(3): 294-7.  Back to cited text no. 13    
14.De Shazo CV, Simmons RL, Bernstein DM, et al. Results of renal transplantation in 100 children. Surgery 1974;76:461-8.  Back to cited text no. 14    
15.Helin I, Winberg J. Chronic renal failure in Swedish children. Acta Paediatr Scand 1980;69:607-11.  Back to cited text no. 15    

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Correspondence Address:
Said Al-Ghwery
Consultant Pediatric Nephrologist, Pediatrics Department, Riyadh Military Hospital, P.O.Box 7897 (775s), Riyadh
Saudi Arabia
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PMID: 18202474

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  [Table - 1], [Table - 2], [Table - 3], [Table - 4]



 

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Acknowledgment
    References
    Article Tables
 

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