 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. [1] 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. [2]
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. [3]
| 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.
Click here to view |
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. [4],[5] 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%. [7] [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.
Click here to view |
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. [11] 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.
| References | | |
| 1. | Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41:1-12.  |
| 2. | Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987; 34:571-90. [ PUBMED] |
| 3. | VanDeVoorde R, Warady B. Management of chronic kidney disease. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, eds. Pediatricth Nephrology. 6 ed. Berlin, Heidelberg: Springer-Verlag; 2009. p. 1661-93. |
| 4. | Ali el-TM, Abdelraheem MB, Mohamed RM, Hassan EG, Watson AR. Chronic renal failure in Sudanese children: Aetiology and outcomes. Pediatr Nephrol 2009;24:349-53. |
| 5. | Ardissino G, Daccò V, Testa S, et al. Epidemiology of chronic renal failure in children: Data from the ItalKid project. Pediatrics 2003; 111:e382-7. |
| 6. | ESPN/ERA-EDTA Registry (2010) ESPN/ERA-EDTA Registry Annual Report; 2008. |
| 7. | North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). 2007 Annual Report. The EMMES Corporation, Rockville, MD; 2007. |
| 8. | Ahmadzadeh A, Valavi E, Zangeneh-Kamali M. Chronic Kidney Disease in Southwestern Iranian Children. Iran J Pediatr 2009;19:147-53. |
| 9. | Hari P, Singla IK, Mantan M, Kanitkar M, Batra B, Bagga A. Chronic renal failure in children. Indian Pediatr 2003;40:1035-42. |
| 10. | Al-Eisa AA, Samhan M, Naseef M. End-stage renal disease in Kuwaiti children: An 8-year experience. Transplant Proc 2004;36:1788-91. |
| 11. | Naicker S. End-stage renal disease in subSaharan and South Africa. Kidney Int Suppl 2003;83:S119-22. |
Correspondence Address:
Hesham Safouh
Center for Pediatric Nephrology and Transplantation, New Children Hospital, Faculty of Medicine, Cairo University, Cairo, P. O .Box 98, Orman, Giza
Egypt
  | Check |
DOI: 10.4103/1319-2442.160224 PMID: 26178565 
[Table 1], [Table 2], [Table 3] |
