| Abstract|| |
A total of 712 patients with renal problems, aged 13 years or below (mean age 4.12 years) were seen in the Department of Health and Medical Services Hospitals in Dubai in the period from 1991 to 1996. The male to female ratio was 1:1.1. UAE citizens constituted 32% of the total, with a male to female ratio of 1:1.2. Nephrotic syndrome (26.3%) had the highest prevalence among the renal diseases seen, followed by urinary tract infection (19.1%), glomerulonephritis (GN) (9.7%), congenital renal anomalies (9.7%), and chronic renal failure (CRF) (7%). Congenital renal anomalies were the main cause of CRF in our patients followed by GN. Acute renal failure (ARF) occurred in 1.4% of the patients and was not an alarming problem; it had an uncomplicated course and good prognosis. Continuous ambulatory peritoneal dialysis was the mode of replacement therapy for patients with end-stage renal disease. Eight patients underwent renal transplantation; one cadaver donor, four living non-related donor (abroad) and three living related donor.
Keywords: Pediatric renal disease, Dubai, United Arab Emirates.
|How to cite this article:|
Abou-Chaaban M, Al Murbatty B, Majid MA. Spectrum of Pediatric Renal Diseases in Dubai. Saudi J Kidney Dis Transpl 1997;8:310-3
|How to cite this URL:|
Abou-Chaaban M, Al Murbatty B, Majid MA. Spectrum of Pediatric Renal Diseases in Dubai. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2021 Apr 22];8:310-3. Available from: https://www.sjkdt.org/text.asp?1997/8/3/310/39361
| Introduction|| |
Dubai is one of the principal Emirates in the United Arab Emirates and has a population of about 674,000 and a surface area of 3987 square kilometers. The medical service in Dubai is quite advanced and serves its inhabitants as well as parts of the neighboring Emirates. Pediatric nephrology was first recognized as an independent sub-speciality in Dubai in 1991. The number of pediatric renal patients seen has been constantly increasing over the last five years due to better awareness of the nature of renal diseases in children as well as the advanced diagnostic facilities, which have led to early detection and management of renal problems in the pediatric population.
| Patients and Methods|| |
We studied the pattern of pediatric renal diseases among children in Dubai during the period from 1991 to 1996. In this period, a total of 712 pediatric patients aged 13 years or below were seen in the Department of Health and Medical Services (DOHMS) Hospitals in Dubai with various renal problems. The male to female ratio was 1:1.1. Age of the patients at first presentation ranged from one day to 13 years with a mean of 4.1 years. The study group comprised of 230 UAE citizens (32%) with a male to female ratio of 1:1.2.
| Results and Discussion|| |
The number of pediatric renal patients being seen in Dubai has been increasing over the last five years of observation. We believe that this increase is due to several factors including good antenatal care, early diagnosis, adequate intervention, and close follow-up of the patients, all of which will eventually lead to a decrease in the number of patients going to end-stage renal disease (ESRD)  .
The various renal disorders seen in the study children are given in [Table - 1],[Table - 2]. Nephrotic syndrome was the commonest disease encountered and was seen in 187 (26.3%) patients. A total of 13 patients (1.8%) had congenital nephrotic syndrome. Of them, seven expired, six within the first two weeks of life, two foreigners returned to their home countries and the remaining three are on conservative treatment awaiting cadaveric donor renal transplantation. One patient was successfully transplanted with his mother's kidney at the age of three years. He is now five years old and has normal graft function. Renal transplantation has been reported to be the ideal treatment for such patients  . Consanguineous parents was a striking feature among our patients with congenital nephrotic syndrome.
Congenital renal anomalies (CgRA) were seen in 69 patients (9.7%). Vesicoureteric reflux was the commonest lesion seen in 32 patients (46.4%) of whom 22 had bilateral reflux. Other lesions included posterior urethral valve (20; 29.0%) and pelviureteric junction obstruction (12; 17.4%) [Table - 3].
A total of 50 patients (7.0%) presented with chronic renal failure (CRF). The causative factors in these children are given in [Table - 4]. The important finding in our study was the high prevalence of CgRA (30%) and glomerulonephritis (14%) as a cause of CRF. This finding is different from the reports from Saudi Arabia as well as other reports from Jordan wherein pyelonephritis was found to be the main cause of CRF , . However, our results are similar to those published from Europe ,, .
Cystic renal disease (CRD) was seen in 19 patients (2.7%). Infantile polycystic kidneydisease was the commonest CRD, seen in 10 patients (52.6%). The mortality in this group was high with four of them dying in the postnatal period due to hypoplastic lungs.
Seventeen patients (2.4%) presented with ESRD. They were all treated with continuous ambulatory peritoneal dialysis (CAPD), which was started in the hospital and continued at home after imparting adequate training to the parents of the child. CAPD failed in two children aged 11 and 12 years respectively due to non-compliance. Eight children (47%) underwent renal transplantation, the donor source being cadaveric donor in one, living non-related (abroad) in four and living related in three (mother, 2; close relative, one).
Acute renal failure (ARF) was seen in 10 patients (1.4%), averaging two patients per year [Table - 5]. Thus, it was not a major problem among our children. Half of the ARF patients needed dialysis and the remaining could be managed conservatively. None of them developed CRF or ESRD. Hemolytic uremic syndrome (HUS) following Shigella or Salmonella More Details enteritis, as a cause of ARF, was seen in two patients.
Cystinosis with renal involvement was seen in eight patients (1.1%). All these patients developed CRF; three expired and one underwent cadaveric kidney transplantation. Children of Palestinian origin had the highest prevalence of cystinosis (62.5%) and all the affected children had consanguineous parents.
Henoch-Schonlein Purpura (HSP) with renal involvement was seen in 15 patients (2.1%). The course was uncomplicated in all these patients and none developed renal functional impairment.
| Conclusion|| |
Nephrotic syndrome will continue to be a challenge to the pediatric nephrologist. Intensive work is needed for understanding better, its nature and etiology in order to influence its course and outcome more effectively. CgRA was the main etiological factor of CRF in our patients. Consanguineous marriage was a common factor in all the hereditary diseases in our study children, e.g. Cystinosis, IPCKD and CgNS.
The outcome, course and prognosis of most of the renal diseases in the pediatric agegroup, can be influenced by early diagnosis, close observation and prompt intervention. CAPD has proven to be superior to other modes of dialysis in pediatric ESRD patients in Dubai. A national program for cadaveric organ transplantation is urgently needed to make the life of children with ESRD easier, and give them hope for a better future.
| References|| |
|1.||Gusmano R, Perfumo F. Worldwide demographic aspects of chronic renal failure in children. Kidney Int Suppl 1993;41:S31-5. [PUBMED] |
|2.||Mahan JD, Mauer SM, Sibley RK, Vernier RL. Congenital nephrotic syndrome: evolution of medical management and results of renal transplantation. J Pediatr 1984;105:549-57 [PUBMED] |
|3.||El Aun M, Hazza I, Oudah 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 Transplant 1995;6(3):290-3. |
|4.||Mattoo TK, Al Mohalhal S, Al Sowailem AM, Al Harib M, Mahmoud MA. Chronic renal failure in chidren in Saudi Arabia. Ann Saudi Med 1990:10:469-9. |
|5.||Habib R, Broyer M, Benmaiz H. Chronic renal failure in chidren. Causes, rate of deterioration and survival data. Ncphron 1973;11:209-20. |
|6.||Potter DE, Holliday MA, Piel CF, Feduska NJ, Belzer FO, Salvatierra O Jr. Treatment of end-stage renal disease in children, a 15year experience. Kidney Int 1980;18:103-9. [PUBMED] |
|7.||Zilleruelo G, Andia J, Gorman HM, Strauss J. Chronic renal failure in children: analysis of main causes and deterioration in 81 children. Int J Pediatr Nephrol 198O;l:30-3. |
Department of Pediatrics, Dubai Hospital, P.O. Box 21009, Dubai
United Arab Emirates
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]