Chronic Kidney Diseases in Iraqi Children
Iraqi Postgraduate Medical Journal,
2007, Volume 6, Issue 3, Pages 240-251
Chronic renal insufficiency (CRI) causes substantial morbidity in virtually every major organ system of the body. Moreover; CRI is inevitably progresses to end stage renal disease.
To find out the frequency of chronic renal failure in pediatric age group and their risk factors.
One hundred ten infants, children and adolescents with chronic renal failure age between 1 mo.-17 yr. visiting Al-Karama Teaching Hospital in nephrology, urology, dialysis and transplant units for the period from1st May 2004 until 30th April 2006 were included in this study. Patient's notes were reviewed for: Age, sex, age at first presentation, age at referral to pediatric nephrologists , medical and social history including mode of their RRT, then the cause of their renal failure. Every patient was clinically examined and blood pressure. Measurement was taken, followed by taking anthropometric measurements which includes body weight (Kg) and height (cm) in addition to assessment of sexual maturity rate stages lastly we record laboratory investigation which include blood urea, S. creatinine, Hb. level , S. Ca+2, S.Ph., and GFR in addition to any investigations regarding original renal disease.
In this study we found that males are more affected than females in a ratio of 3.2/1. The mean age at their 1st presentation were 3.5 ± 3.7 yrs. while their mean age when they referred to pediatric nephrologists were 5.2 ± 4.4 yrs. Below 5 yrs. constituting 44.5% and age group between 6-10 yrs constituting 29.1% while in age group above 10 yrs were 26.4%. Mean value of GFR in this study was 14.2 ± 7.5 ml/min/ 1.73m2, 36.4% patients were in ESRD. Obstructive uropathy as a cause of CRF were in 34.5% of total patients, followed by glomerular diseases that involves 21.8% and congenital anomalies of urinary system in 20.9% of our patients in this study. About 80% of our patients were found to be anemic with Hb concentration ≤ 10 g/dl and 48.1% of patient having hypocalcemia with S. Ca+2 level <9.5 mg/dl and hyperphosphatemia with S.Ph. >5.5 mg/dl found in 32.7% of patients.This study shows a significant relationship between hypocalemia and hyperphosphatemia and anemia with progression of renal insufficiency to ESRD. About 45.5% and 53.6% were below 3rd centile for Wt. and Ht. respectively and more than 50% had delayed puberty on SMR staging of Tanner and those patient's with growth retardation are significantly increased in number as the disease progressed to ESRD.Hypertension considered in patient with BP > 95th percentile according to task force table for age and sex and wt. and Ht. percentile and accordingly our study show that about 45.5% of patients were HTN. Mode of RRT is mainly conservative and intermittent peritoneal dialysis in 41.8% and 40% of our patients respectively. While only one patient was on APD and 11 patients were on HD and 8 patients received lived related & unrelated renal transplant.
The obstructive uropathy is the commonest cause for CRF especially in children <5 yrs. Most of our patients were of delayed referral to pediatric nephrology and they are poorly managed, severely affected and growth retarded. We have limited diagnostic resources & options regarding pediatric dialysis programs & renal transplant.
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