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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1997  |  Volume : 8  |  Issue : 3  |  Page : 317-319
Spectrum of Pediatric Renal Diseases in Tunisia


Department of Pediatric Nephrology, Hospital Charles Nicolle, Tunisia

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How to cite this article:
Kamoun A. Spectrum of Pediatric Renal Diseases in Tunisia. Saudi J Kidney Dis Transpl 1997;8:317-9

How to cite this URL:
Kamoun A. Spectrum of Pediatric Renal Diseases in Tunisia. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2020 Oct 30];8:317-9. Available from: https://www.sjkdt.org/text.asp?1997/8/3/317/39363
Socioeconomic, geographical and genetic factors play important roles in determining the prevalence and pattern of renal diseases in each part of the world. There is no doubt that local conditions in Tunisia such as poverty, malnutrition, poor hygienic conditions and high rate of consanguinity play a major role in the development of several renal diseases in childhood.


   Chronic Renal Failure Top


The first pediatric nephrology unit in Tunisia was opened seven years ago. The various aspects of pediatric chronic renal failure were studied in a group of young patients aged less than 15 years, transferred to our department for the management of end-stage renal disease (ESRD). Between January 1990 and March 1997, 134 children with ESRD were admitted to our department.

The incidence of ESRD in children under 15 years in Tunisia, estimated over a period of four years and, including children dialyzed in adult dialysis centers, was seven new cases per million children per year [1] . This incidence is comparable to that reported in European or American series [2],[3],[4] . However, this incidence may be an under-estimation and some children who have reached ESRD might not have been included in our series. These might be either children who died before transfer to our department or children whose parents chose not to dialyze them.

The male-female ratio in our pediatric ESRD series was 1.83, while it was close to one in European series [2],[3],[4] . Parental reluctance to allow daughters to undergo dialysis cannot be excluded and would explain the abnormally increased sex ratio in our series. Analysis of the etiology of ESRD in Tunisian children showed that glomerulonephritis (GN) and hereditary nephropathies constituted the most important etiological groups [Table - 1].

Among hereditary nephropathies, the prevalence of nephronophthisis, cystinosis, autosomal recessive polycystic kidney disease and Alport's syndrome was similar to the European or the American series [3],[4] . However, the prevalence of primary hyperoxaluria in our series was very high. Primary hyperoxaluria accounts for 1% of ESRD in Europe [3] , 0.2% in USA [4] , and 13% in Tunisia. This high prevalence could partly be explained by the high rate of consanguinity (35%) that exists in Tunisia. Alport's syndrome was found in four of our patients with ESRD. Three of these patients were female and seemed to show, according to investigation of the family, the autosomal recessive form. Thus, the high consanguinity rate in our country gives particular features to Alport's syndrome with the autosomal recessive forms becoming prevalent.

Glomerulonephritis represented the second commonest cause of ESRD. Within this group, focal segmental glomerulosclerosis predominated. Despite the increased frequency of its occurrence in our country, post­streptococcal GN does not seem to contribute in a significant way to pediatric ESRD. In our series, no case of ESRD could be attributed to post-streptococcal GN- The frequency of membranoproliferative GN is constantly decreasing in Europe. Its frequency in our series (2%) is comparable to that in Europe (3%), the United States (2.9%), and Brazil (3.3%) [3],[4],[5] .

The frequency of malformative uropathies and of dysplastic-hypoplastic kidneys seems to be low in our country. These nephropathies represented respectively 16.4% and 4.5% of the etiology of ESRD in Tunisia and 24% and 14% in Europe [6] . The etiology of ESRD could not be identified in 23.9% of the children. These were generally children whose renal insufficiency was identified at a late stage in its course. Similar rates of unknown etiology have been seen in the series from other developing countries as well [5]

Treatment with dialysis was started on 75% of the children with ESRD. Once maintenance dialysis is commenced in our department, patients with medical insurance are sent to a private center near the patient's home for continuation of hemodialysis. Children with ESRD belonging to the lower socio economic classes without health insurance, are given regular dialysis treatment in our dialysis center. Because of the distance between their homes and our hospital, some of our patients had to be admitted to the hospital for long periods of time. Among the 134 patients who reached ESRD during the study-period, renal transplantation was performed in only seven cases. In all cases, the donors were living-related.


   Urinary Tract Calculi Top


Urolithiasis is seen very frequently in Tunisia with about 25% of the stones being located in the urinary bladder. The composition of the stones was as follows: acid ammonium urate in 40% of the cases suggestive of malnutrition with phosphorus deficiency, and struvite in 15% of the cases indicating urinary tract infection by urease­positive bacteria [7] . In 10% of cases, the urinary stones were due to a hereditary lithogenic metabolic disease. Whereas primary hyperoxaluria appears to be frequent in Tunisia, other hereditary lithogenic metabolic diseases such as cystinuria and distal renal tubular acidosis have similar prevalence rates as in Europe.

 
   References Top

1.Kamoun A, Lakhoua R. End-stage renal disease of the Tunisian child: epidemiology, etiologies, and outcome. Pediatr Nephrol 1996;10:479-82.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Donckerwolcke MA, Broyer M, Brunner FP, ct al. Combined report on regular dialysis and transplantation of children in Europe, XI, 1981. Proc Eur Dial Transplant Assoc 1982;19:61-86.  Back to cited text no. 2    
3.Brunner FP, Broyer M, Brynger H, et al. Demography of dialysis and transplantation in children in Europe, 1985. Report from the European Dialysis and Transplant Association Registry. Nephrol Dial Transplant 1988;3:235-43.  Back to cited text no. 3    
4.Anonymous. End-stage renal disease in children. Am J Kidney Dis 1991;18 (Suppl 2):79-88.  Back to cited text no. 4    
5.Garcia C, Goldani J, Garcia V. Pacdiatric dialysis and renal transplantation in the state of Rio Grande do Sul, Brazil. Pediatr Nephrol 1992;6;74-7.  Back to cited text no. 5    
6.Broyer M, Chantler C, Donckerwolcke R, Ehrich JH, Rizzoni G, Scharer K. The Paediatric registry of the European Dialysis and Transplant Association: 20 year's experience. Pediatr Nephrol 1993;7:758-68.  Back to cited text no. 6    
7.Kamoun A, Daudon M, Kabaar N, et al. Etiologic factors of urinary lithiasis in Tunisian children. Prog Urol 1995;5:942-45.  Back to cited text no. 7  [PUBMED]  

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Correspondence Address:
Ayoub Kamoun
Department of Pediatric Nephrology, Hospital Charles Nicolle, Bd du 9 avril 1936, Tunis 1006
Tunisia
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PMID: 18417814

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