Etiology of chronic renal failure in children; experience at king Hussein medical center

To determine the spectrum and etiology of chronic renal failure, for patients followed up in the pediatric nephrology clinic at King Hussein Medical Center, as well as to determine the prevalence and other demographic features for patients with chronic renal failure in Jordan. A registry analysis of all children with chronic renal failure followed in the pediatric nephrology clinic at King Hussein Medical Center during the year 2004 was conducted. Chronic renal failure was defined as having glomerular filtration rate <80 ml/ min / 1.73m[2]. Demographic data such as sex, height, and date of birth, as well as the serum BUN, creatinine, diagnosis and the duration of chronic renal failure at the time of follow up were all recorded. Chronic renal failure was calculated from serum creatinine based on Schwartz formula. CRF was divided to 4 stages according to the Kidney Disease Outcomes Quality Initiatives guidelines, for stratification of chronic kidney disease. A total number of 117 patients, 64 [54.7%] males, and 53 [45.3%] females were included in the study. Statistical Package for Social Studies version 10 was used to analyze the data. Values are given in means +/- standard deviation unless otherwise stated. The mean age was 8.6 +/- 4.7 years, and the mean duration of follow up was 6.7 +/- 2.3 years. The mean glomerular filtration rate for the whole study population at the time of recording was 28.6 +/- 19.58 ml/min/ 1.73m[2]. It was shown that the prevalence of chronic renal failure among Jordanian children in the year 2004 to be 75 patients per million-child population. The most common cause of chronic renal failure was Reflux Nephropathy [30.8%] of total, followed by Neurogenic Bladder [17.9%]. Reflux Nephropathy, and Obstructive Uropathy were more common in males when compared to females; where as Neurogenic Bladder and Hemolytic Uremic Syndrome were more common in females. The most common cause of chronic renal failure in patients with end stage renal disease at King Hussein Medical Center was glomerulonephritis [19.4%], followed by oxalosis [16.1%].The etiology of chronic renal failure in Jordan is similar to other places with some peculiar features that need further study including the high prevalence of neurogenic bladder, and oxalosis. The importance of establishing a national and possibly regional registry system for pediatric chronic renal failure is well illustrated by this study

Spectrum of biopsy-proven renal disease in the pediatric age group at King Hussein Medical Center

This is a retrospective analysis of kidney biopsies done for children with glomerular diseases in the pediatric age group. The medical records of all children who underwent kidney biopsy between January 1999 and June 2003 were studied. Demographic data including age and gender, as well as the indication for biopsy, the result, the diagnostic value, and complications of the procedure were recorded. All biopsies were done under ultrasound guidance. A total number of 65 biopsies were done. Four were in previously diagnosed patients to rule out cyclosporine toxicity and therefore excluded from the study The biopsy was inadequate in three cases [46%] All of the remaining 58 biopsies were included in the study and analyzed. The mean age at biopsy was 7.56 +/- 4.22 years. Renal disease was more common in males [62.1%]. The most common indication for biopsy was steroid resistant nephrotic syndrome accounting for 32.7% of the cases. The most common primary glomerular disease at renal biopsy was focal segmental glomerulosclerosis occurring in 19% of patients followed by mesangiocapillary glomerulo-nephritis and then minimal change disease. The most common secondary renal disease was Henoch-Schoenlein purpura representing 6.9% of cases followed by systemic lupus erytheniatosus in 3.4% of eases. The kidney biopsy was normal in 5.2% of patients. When patients with difficult nepbrotic syndrome were analyzed the most common lesion was local segmental glomerulosclerosis in 39.1%. Mesangiocapillary glomerulonephritis was present in 26.1%, minimal change disease in 17.4%, diffuse mesangial nephritis in 13% and congenital nephrotic syndrome in 4.3%. Gross hematuria was noticed in eight [13.8%] patients' however blood transfusion was only needed in two [3.4%] patients. One patient [1.7%] required radiological intervention for AV fistula post biopsy. The distribution of renal disease in the pediatric age group at King Hussein Medical Center is similar to that described in other countries with some differences. The kidney biopsy is safe and the diagnostic yield is excellent. Taking into account the lack of reliable data in Jordan this study illustrates die importance of having a regional registry for renal disease in children