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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1997  |  Volume : 8  |  Issue : 3  |  Page : 314-316
Spectrum of Pediatric Renal Diseases in Jordan


Department of Pediatrics, King Hussein Medical Center, Amman, Jordan

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How to cite this article:
Hazza I, Mughraby H, Najada A. Spectrum of Pediatric Renal Diseases in Jordan. Saudi J Kidney Dis Transpl 1997;8:314-6

How to cite this URL:
Hazza I, Mughraby H, Najada A. Spectrum of Pediatric Renal Diseases in Jordan. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2020 Oct 1];8:314-6. Available from: http://www.sjkdt.org/text.asp?1997/8/3/314/39362
The pediatric nephrology service at the King Hussein Medical Center, Amman, Jordan serves a group of hospitals that altogether receive about 1.9 million pediatric visits per year. The pattern of childhood renal disorders in Jordan is fairly similar to that in other parts of the world, although the frequency of occurrence of various diseases appears to be different [1] . Most of the acute renal disorders and urinary tract anomalies are managed by the attending pediatricians and only when a case is complicated or there is evidence of chronic renal involvement, that the case is referred to our service.

Post-streptococcal glomerulonephritis is the most common form of acute glomerulonephritis seen in Jordanian children and it is associated with pharyngotonsillitis, and not with pyoderma as seen in some tropical countries [1] . Acute nephritis associated with Henoch Schonlein purpura occurred in 17% of the reviewed cases [2] , all of whom were associated with raised ASO titer; none of the studied patients had persistent renal involvement or chronic renal failure.

Hemolytic Uremic Syndrome accounts for the majority of early referrals for patients with acute renal failure needing renal replacement therapy. Our patients had a good outcome; of nine cases who needed acute peritoneal dialysis during the last year, all, except one who died, recovered completely. All our cases had history of a diarrheal prodrome prior to renal involvement and this cluster of patients is most probably an epidemic form that needs further study.

Nephrotic syndrome was the most frequent problem seen in our out-patient clinic. We saw a total of 125 patients during a 10 year period. The male to female ratio was 2.1:1 with a mean age at onset of 4.8 years. Other demographic features are similar to those reported by others [3],[4],[5] . Steroid responders in our patients reached 77%. approaching 80% reported from the western world [6],[7] . Frequently relapsing course of the syndrome occurred in about 65% of our patients which is higher than the 50% prevalence reported elsewhere [6] . This may be partly explained by the fact that we are seeing a selected population of patients through referral cases. Steroid resistance was encountered in 23% of our patients. In this group, mesangial proliferative glomerulonephritis was found in half of the biopsied cases, a finding that is similar to that reported by others from our area [1] .

There is a considerable increase in the number of children presenting with chronic renal failure (CRF) in the last few years owing in part to increased recognition and referral of cases with renal problems that lead to CRF and the availability of renal replacement therapy. We have currently a total of 87 children suffering from CRF.

Chronic pyelonephritis including reflux nephropathy and obstructive uropathy accounted for about 50% of cases of CRF in our series [8] . Heredofamilial causes accounted for only 11% of cases. However, since the publication of the earlier report, and owing to the improvement in diagnosis and management of such disorders, heredofamilial disorders have become more recognizable contributing to 23% of the cases of CRF. Glomerulonephritis accounted for 9.2% of the cases of CRF in our study children [Table - 1].

Reflux nephropathy is still the leading cause of CRF in our children accounting for 37.9% of the cases. A total of 139 patients with vesicoureteric reflux (VUR) were seen and followed-up in the pediatric nephrology clinic; 115 patients had primary and the remaining 24 patients had secondary VUR. Urinary tract infection was the presenting symptom in 83% of the cases [9] ; all children diagnosed after the age of five years had scarred kidneys in comparison with only 50% of children diagnosed below the age of five years [10] .

The other heredofamilial nephropathies encountered are listed in [Table - 2]. The high prevalence of VUR as a cause of CRF in our series emphasises the necessity for investigating thoroughly children with urinary tract infection for making early diagnosis and prompt treatment of preventable causes of CRF.

Among our patients with end-stage renal failure, glomerulonephritis was the most frequent cause (33.3%) followed by congenital hypodysplasia (23.8%) and chronic pyelonephritis (19%) [8] . Eleven cases are receiving peritoneal dialysis as replacement therapy and nine patients are on hemodialysis. The mortality rate among our patients with end-stage renal failure was 52.2% [8] . The reasons for this high mortality rate include delay in commencement of renal replacement therapy, inadequate facilities for the care of children with end-stage renal failure and/or poor compliance to therapy. These factors are common to all developing countries in which, for a number of reasons, renal transplantation in children is still not a well established mode of therapy.

 
   References Top

1.Hamed R. Childhood renal disorders in Jordan. J Nephrol 1995;8(3):162-6.  Back to cited text no. 1    
2.Al Aun M, Najada A, Hazza I, et al. Renal involvement in Henoch­Schonlein Purpura. Saudi J Kidney Dis Transplant 1997;7(l):34-5.  Back to cited text no. 2    
3.Schlesinger ER, Sultz HA, Mosher WE, Feldman JG. The ncphrotic syndrome its incidence and implications for the community, Am J Dis Child 1968;116:623-32.  Back to cited text no. 3    
4.Zaki M, Helin I, Manadhar S, Hunt MC, Khalil AF. Primary nephrotic syndrome in Arab children in Kuwait. Pediatr Nephrol 1989;3:218-21.  Back to cited text no. 4    
5.Elzouki AY, Amin F, Jaiswal OP. Primary nephrotic syndrome in Arab children. Arch Dis Child 1984;59:253-5.  Back to cited text no. 5  [PUBMED]  
6.Consensus statement on management and audit potential for steroid responsive nephrotic syndrome. Report of a Workshop by the British Association for Pacdiatric Nephrology and Research Unit, Royal College of Physicians. Arch Dis Child 1994;70:151-7.  Back to cited text no. 6    
7.The primary nephrotic syndrome in children, Identification of patients with minimal change nephrotic syndrome from initial response to prednisolone. A report of the International Study of Kidney Diseases in Children. J Pediatr 1981;98:561-4.  Back to cited text no. 7    
8.El Aun M, Hazza I, Qudah E, Najada A, 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.  Back to cited text no. 8    
9.El Aun M, Hazza I, Ajluni S, et al. Vesico ureteric reflux: a report of 47 cases. J Royal Med Services 1997;4:50-2.  Back to cited text no. 9    
10.Hazza I, Wahadeneh A, Qudah E, Ahmad M. Vesico ureteric reflux and renal scarring in children with urinary tract infection. Saudi J Kidney Dis Transplant 1996;7(l):24-6.  Back to cited text no. 10    

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Correspondence Address:
Issa Hazza
Department of Pediatrics, King Hussein Medical Center, P.O. Box 960955, Amman 11196
Jordan
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PMID: 18417813

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