Chronic Kidney Disease in Children Aged 6-15 Years and Associated Risk Factors in Apizaco, Tlaxcala, Mexico, a Pilot Study.

INTRODUCTION: Tlaxcala, a small state in central Mexico, has the highest prevalence of chronic kidney disease (CKD) deaths in population aged 5-14 in Mexico, most of them with unknown etiology. OBJECTIVE: To determine the prevalence of CKD in apparently healthy pediatric population in Apizaco, Tlaxcala. METHODS: A cross-sectional pilot study was carried out in children deemed as healthy; subjects with previous diagnosis of CKD were excluded. Informed consent was obtained in all cases. A physical examination was performed, a questionnaire was applied. Blood and urine samples were obtained for serum creatinine, urinalysis, and microalbumin/creatinine ratio. A second and third evaluation was performed after 6 and 18 months in those found with urinary anomalies/CKD to confirm the diagnosis. RESULTS: One hundred and nine subjects completed physical examination, which are the biological samples. Median age was 12 years. CKD stage 2 was confirmed in 5 subjects in the sixth month confirmation visit (4.6%). One patient accepted renal biopsy and Alport Syndrome was found. In a robust multivariate analysis, the risk factors related to reduction in the glomerular filtration rate were males -5.15 mL/min/1.73 m2 (p = 0.002), older participants as by -1.58 mL/min/1.73 m2 per year (p < 0.0001), and among participants living close to a river -3.76 mL/min/1.73 m2 (p = 0.033). DISCUSSION/CONCLUSION: The prevalence of CKD in the population studied in Apizaco Tlaxcala was confirmed in 4.6 cases per 100 inhabitants between 6 and 15 years. Males, older age, and living close to a river were the risk predictive factors. More studies are needed to determine the causes of the high CKD prevalence in this population.

En hospitales d México: criterios de asignación de riñón de pacientes fallecidos / Mexico: criteria for the assignment of kidneys of deceased patients

En México, los riñones de donador fallecido se asignan a los receptores de conformidad con la Ley General de Salud que no proporciona criterios claros de distribución, y por desgracia no se hacen pruebas de histocompatibilidad. Para evaluar los criterios de asignación utilizamos un cuestionario con información de cinco historias clínicas de pacientes en lista de espera para un trasplante, y se les preguntó por el orden para recibir el órgano. Los resultados mostraron que no hubo criterios comunes dentro de cada hospital ni entre los hospitales comparados entre sí. En condiciones ideales debería existir un sistema de puntaje para la asignación de órganos de paciente fallecido que incluya las pruebas de histocompatibilidad.

In Mexico, kidneys from deceased donors are assigned to recipients in accordance with the General Health Act, which provides no clear criteria on distribution and, unfortunately, no histocompatibility tests are done. A questionnaire with information concerning five case histories of patients on a waiting list for a transplant was used to evaluate the criteria on allocation. The questionnaire was applied by asking in what order the patients would be assigned a kidney. The results showed there were no common criteria within each hospital or among the hospitals in the sample. Under ideal conditions, there should be a point system for assigning organs from deceased donors that includes histocompatibility tests.

Em México, os rins de doador falecido atribuem-se aos receptores seguindo a Lei General de Saúde. No entanto, esta não dá critérios claros de atribuição nem se fazem provas de histocompatibilidade. Para avaliar os critérios de atribuição, usamos um questionário com informação de cinco histórias clínicas de pacientes estarem em uma lista de espera para transplante. Foram perguntados pela ordem para receber o órgão. Os resultados revelaram que no existem critérios comuns em cada hospital nem entre os hospitais comparados entre si. Em condições ideais, deveria existir um sistema de puntagem para a atribuição de órgãos de paciente falecido, que inclua provas de histocompatibilidade.