| Abstract|| |
There are very few published reports on the causes of chronic kidney disease (CKD) in Egyptian children. We reviewed the records of 1018 (males 56.7%, age ranged from 1 to 19 years) Egyptian patients suffering from CKD and followed-up at the pediatric nephrology units (outpatient clinics and dialysis units) of 11 universities over a period of two years. The mean of the estimated glomerular filtration rate was 12.5 mL/min/1.73 m 2 . Children with CKD stage I and stage II comprised 4.4% of the studied group, while those with stage III, IV and V comprised 19.7%, 18.3% and 57.6%, respectively. The most common single cause of CKD was obstructive uropathy (21.7%), followed by primary glomerulonephritis (15.3%), reflux/urinary tract infection (14.6%), aplasia/hypoplasia (9.8%) and familial/metabolic diseases (6.8%); unknown causes accounted for 20.6% of the cases. Of the 587 patients who had reached end-stage renal disease, 93.5% was treated with hemodialysis and only 6.5% were treated with peritoneal dialysis.
|How to cite this article:|
Safouh H, Fadel F, Essam R, Salah A, Bekhet A. Causes of chronic kidney disease in Egyptian children. Saudi J Kidney Dis Transpl 2015;26:806-9
|How to cite this URL:|
Safouh H, Fadel F, Essam R, Salah A, Bekhet A. Causes of chronic kidney disease in Egyptian children. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Apr 18];26:806-9. Available from: https://www.sjkdt.org/text.asp?2015/26/4/806/160224
| Introduction|| |
Chronic kidney disease (CKD) is recognized as a major public health problem.  However, the magnitude of CKD varies from one geographical area to another due to genetic and environmental factors.
In the absence of a national registry, the exact incidence and burden of CKD in children in Egypt is not known. A review of the available literature reveals a paucity of information on the etiology of CKD in Egyptian children. There are only anecdotal data from one or two centers but no published or indexed international references. In a developing country such as Egypt, with limited diagnostic resources and poor-quality primary health care, end-stage renal disease (ESRD) is probably the "tip of the iceberg," where patients are diagnosed with renal disease when they have already reached the end-stage renal failure.
We aim in this study to determine the etiology of CKD in Egyptian children and compare the results to other pediatric populations.
| Patients and Methods|| |
We retrospectively reviewed the records of 1018 Egyptian children (ages from 1 to 19 years, males 56.7%) suffering from CKD of all stages and followed-up at the pediatric nephrology units (outpatient clinics and dialysis units) of 11 universities providing tertiary medical care to children from all Egyptian governorates during the year 2012-2013 [Table 1]. We excluded all patients with acute kidney disease of any etiology.
Glomerular filtration rate (GFR) was estimated by the Schwartz formula. The value of the variant k (according to age and gender) was 0.33 in pre-term infants, 0.45 in full-term infants, 0.55 in children and adolescent girls and 0.70 in adolescent boys. 
The survey included inquiries about the demographic, clinical, etiological and therapeutic parameters of the patients. The textbook of Pediatric Nephrology was used as a guideline for the diagnostic criteria of the underlying diseases. 
| Statistical Analysis|| |
The SPSS 13.0 software was used to perform the descriptive and analytical statistics and Pvalues <0.05 were considered as significant.
| Results|| |
Children with CKD stage I and stage II comprised 4.4% of the studied group, while those with stage III, IV and V comprised 19.7%, 18.3% and 57.6%, respectively.
The etiology of CKD and the characteristics of our patients are shown in [Table 2]. The most common single cause of CKD was obstructive uropathy (21.7%), followed by primary glomerulonephritis (15.3%), reflux/urinary tract infection (14.6%), aplasia/hypoplasia (9.8%) and familial/metabolic diseases (6.8%). Unknown causes accounted 20.6% of the cases.
|Table 2: Etiology of chronic kidney disease (CKD) and characteristics of our patients.|
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Of the 587 patients who had reached ESRD, 549 (93.5%) were treated by hemodialysis in different university hospitals and only 38 (6.5%) were treated by peritoneal dialysis at the Alexandria University. Some universities, namely Assiut and El Menoufia, had no patients on conservative treatment.
The mean age of the patients receiving hemodialysis, conservative treatment and peritoneal dialysis was 9.9 (±4.2), 7.8 (±4.3) and 8.6 (±4) years, respectively.
| Discussion|| |
Our study reports the etiology and treatment modalities as well as geographic distribution of CKD pediatric patients in Egypt based on the population of children referred to university hospitals, which represent tertiary care hospitals all over Egypt. The geographical data in our study only roughly represent the true geographical distribution of CKD patients as many patients seek or are referred to university hospitals in other governorates (especially Greater Cairo and Alexandria) for diagnosis or initiation of renal replacement therapy (RRT), sometimes even for mere conservative management. Like most developing countries, the medical registration system in Egyptian university hospitals has many flaws and varies greatly from one hospital to another, and is largely left to the initiative and perseverance of the individual nephrologists.
Male preponderance in our patients is in accordance with other studies from different parts of the world. , This is largely attributed to the high incidence of congenital urological malformations.
Congenital urological malformations (obstructive uropathy, vesicoureteric reflux, hypoplasia/ dysplasia) comprised 46% of the underlying etiology in our patients. Unlike in developed countries, where antenatal diagnosis allows for prompt surgical correction soon after birth, congenital urological problems in our country are diagnosed late following recurrent episodes of urinary tract infections; intervention is thus delayed.
Primary glomerulonephritis (focal segmental glomerulonephritis, rapidly progressive glomerulonephritis, lupus nephritis, membranoproliferative nephritis and membranous nephropathy) ranked the second among CKD etiologies in our patients, and familial/metabolic disorders ranked the third. In 20.6% of the patients, the etiology could not be identified, mostly because of late presentation with shrunken kidneys, where biopsy would be of little benefit. A similar study from our neighboring country, Sudan, showed that primary glomerulonephritis was the most common cause in 25.4%, and the cause was unidentifiable in 40%, while congenital urological malformations accounted for 17.5%.  [Table 3] shows CKD causes among children in our study compared with some other countries.
|Table 3: Chronic kidney disease (CKD) among children in our study compared with some other countries.|
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Because 57.6% of our patients presented in stage V, it is obvious that the early stages were missed. Very poor public health awareness, late detection/referral by primary and secondary care centers and poor access of patients from rural and remote areas to tertiary care centers make early detection of CKD an exception. In addition, patients may apply directly to tertiary health care centers.
Our study showed that 53.9% of children were treated by hemodialysis, in contrast to only 4.1% who were treated by peritoneal dialysis.
Among the 53 African countries, peritoneal dialysis is available in only 12 (23%; five in Northern Africa, seven in Southern Africa) and is being delivered only in the public sector. Most of these units offer acute manual intermittent peritoneal dialysis and only a few perform continuous ambulatory peritoneal dialysis.  Successful peritoneal dialysis requires highly motivated, educated and financially supported patients/parents with acceptable levels of personal hygiene. In addition, peritoneal dialysis has a bad image in Egypt, as many patients and doctors are only aware of intermittent peritoneal dialysis whereby patients are dialyzed for at least 18 h/session, two to three sessions per week, via rigid and painful catheters, with most patients eventually dying from peritonitis.
We conclude that our study would form the basis of a permanent registry for CKD cases in children in Egypt. More effort and research is needed to improve the understanding of the differences in incidence between countries, causes and progression of CKD in order to prevent renal failure
Conflict of interest: None declared.
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[Table 1], [Table 2], [Table 3]