| Abstract|| |
A study was conducted on chronic renal failure patients treated by medications or by hemodialysis at The Martyr Dr. Khalil Sulaiman Hospital in Jenin city, Palestine, from 1/8/2005 to1/8/2006 to know the underlying etiology of chronic renal failure. The subjects included were 84 patients. The information was obtained from files of the patients. The diagnosis was based on medical history, laboratory tests, X-rays, CT scans, ultrasound and renal biopsies. The results showed that the three most common causes of chronic renal failure in Jenin district were diabetes mellitus (33.32%), hypertension (16.7%), and chronic glomerulonephritis (13.1%). Inherited kidney diseases formed an important percentage (17.85%) and included primary hyperoxaluria (10.71%), Alport's syndrome (5.95%), and adult polycystic kidney disease (1.19%). These results differ from what is found in most developing countries including many Arab countries where the principal causes of chronic renal failure are chronic glomerulonephritis and interstitial nephritis. The high prevalence of inherited kidney diseases in some families (primary hyperoxaluria and Alport's) syndrome may be explained by the very high prevalence of consanguineous marriage especially among cousins in these families.
|How to cite this article:|
Abumwais JQ. Etiology of chronic renal failure in Jenin district, Palestine. Saudi J Kidney Dis Transpl 2012;23:158-61
| Introduction|| |
Chronic kidney disease (CKD) is a pathophysiological process with multiple etiologies, resulting in the inexorable attrition of nephron number and function and frequently leading to end-stage renal disease (ESRD). 
Wide geographical variations in the incidence of disorders causing CKD exist. The most common cause of glomerulonephritis in sub-Saharan Africa is malaria. Schistosomiasis is a common cause of renal failure due to urinary tract obstruction in parts of the Middle East, including southern Iraq.  Glomerulonephritis is the most common cause of chronic renal failure in Sudan. , In United States of America, diabetes and hypertension are the leading underlying etiologies of both CKD and ESRD. 
The incidence of end-stage renal failure varies between racial and age groups, as does the relative importance of different causes of chronic renal failure. 
Disorders with clear-cut monogenic inheritance comprise a small but important component of the etiologies of CKD such as autosomal dominant polycystic kidney disease, Alport's syndrome, and inherited forms of focal segmental glomerular sclerosis. Nephronopthisis, medullary cystic kidney disease, and Fabry's disease are among other rare causes of progressive CKD. In contrast, the two most common etiologies of CKD, diabetes mellitus (both types 1 and 2) and essential hypertension, display complex polygenic patterns of inheritance. 
The aim of the study was to know the underlying etiology of chronic renal failure in Jenin district which includes Jenin city and the surrounding villages.
| Materials and Methods|| |
This study has been conducted on chronic renal failure patients of Jenin district, which includes Jenin city and the surrounding villages with a population of about 280,000 persons.
The subjects were 84 patients treated by medications or hemodialysis at The Martyr Dr. Khalil Sulaiman Hospital in Jenin city from 1/8/2005 to 1/8/2006. The results were obtained from files of the patients in the kidney unit. The diagnosis was based on medical history, laboratory tests, X-rays, ultrasound, CT scans, and renal biopsies.
| Results|| |
[Table 1] shows that the leading cause of CKD in our patients was diabetes mellitus (33.3%), followed by hypertension (16.7%), and glomerulonephritis was the third most common cause (13.1%). Oxalosis (primary hyperoxaluria) was the fourth common cause (10.71%); when we consider the inherited disorders (Oxalosis, Alport's syndrome and polycystic kidney disease) together in the category of inherited kidney diseases, they will occupy the second most common cause of chronic renal failure in Jenin District (17.85%).
|Table 1: The etiology of chronic kidney disease (CKD) in the study patients; number of patients (N), percentage (%).|
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[Table 2] shows that consanguineous marriage increased the incidence of inherited kidney diseases such as (primary hyperoxaluria, Al-port's syndrome), congenital anomalies, and some diseases such as diabetes mellitus and hypertension.
|Table 2: The degree of relativity between parents of the study patients; number of patients (N), percentage (%).|
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| Discussion|| |
We found that the three most common causes of chronic renal failure in Jenin District were diabetes mellitus, hypertension, and chronic glomerulonephritis; responsible together for (63.12%) of all cases. These results, in general, are similar to what was found in Korea.  However, the results differ from what is found in most developing countries including many Arab countries, where the principal causes of chronic renal failure are chronic glomerulonephritis and interstitial nephritis. 
The most common cause of chronic renal failure in Jenin district (diabetes accompanied by hypertension) is in agreement with the fact that diabetes together with hypertension is now the major cause of end-stage renal failure world wide, not only within the developed world, , but also increasingly within the developing countries. 
The high percentage of diabetes mellitus (33.32%) as a cause of ESRD in Jenin district compared to many other developing countries (9.1%-29.9%)  may be explained by the fact that incidence of this disease is markedly increased in some families in Jenin district because of the role of inheritance in this disease and intermarriages among cousins and other relatives in these families because; diabetes mellitus (both types 1 and 2) displays complex polygenic patterns of inheritance.  In this study, 22 patients out of 28 had a family history of diabetes. Unsuccessful or poor control of blood pressure and blood sugar in hypertensive and diabetic patients increases the risk of developing CKD and ESRD.
Furthermore, the high prevalence of hereditary kidney diseases and congenital anomalies of the kidney was due to the very common practice of consanguineous marriages, especially among cousins in some families in Jenin District. Primary hyperoxaluria was found only in one family, while Alport's syndrome was found in several families; consanguineous marriages is a very common practice in the two families suffering from high incidences of primary hyperoxaluria or Alport's syndrome and is repeated from generation to generation.
We conclude that the three most common causes of CKD in Jenin District (Palestine) are diabetes mellitus, hypertension and glomerulonephritis. The high prevalence of inherited kidney diseases, congenital anomalies or malformations, and some other diseases such as diabetes mellitus and hypertension may be due to the very common practice of consanguineous marriage in this area.
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Jamal Qasem Abumwais
Laboratory and Kidney Unit, The Martyr Dr. Khalil Sulaiman Hospital, Jenin City
[Table 1], [Table 2]