Children with chronic renal failure in Sweden 1978-1985

A survey of chronic renal failure (CRF) in Swedish children was carried out for the period 1978-1985, using age-related cut-off levels for creatinine concentrations corresponding approximately to a glomerular filtration rate of 30 ml/min per 1.73 m2. The mean annual incidence of CRF was 6.9 and of terminal renal failure (TRF) 4.4/million children. The prevalence increased during the study period, for preterminal renal failure from 14.1 (1978) to 26.1 (1985) and for TRF from 12.4 to 16/million children. The main groups of primary renal disease were malformations (42%), hereditary disorders (27%), and glomerular diseases (14%), while pyelonephritis with vesico-ureteral reflux only made up 5%.     

Renal failure in Yemen

Renal failure remains a serious cause of mortality in Yemen. Our region has 1.25 million population and our hospital is the central hospital, which has a nephrology department and performs dialysis for the region. Between January 1998 and December 2002, we admitted 547 patients; including children, with acute renal failure (ARF) and chronic renal failure (CRF). CRF was observed in 400 patients, an incidence of 64 per million per year and a prevalence of 320 per million. ARF occurred in 147 persons with an incidence of 23.5 per million per year and a prevalence of 117.5 patients per million. Of all patients, 72% were adults (age range, 20-60 years) with a male preponderance. As a tropical country, malaria (27.9%), diarrhea (13.6%), and other infectious diseases were the main causes. Next most common were obstructive diseases causing CRF and ARF (26.8% and 12.9%, respectively), mainly urolithiasis, Schistosomiasis, and prostatic enlargement. However the cause of CRF in 57.5% of patients was unknown as most persons presented late with end-stage disease (64.7%), requiring immediate intervention. Other causes, such as hepatorenal syndrome, snake bite, diabetes mellitus, and hypertension, showed low occurrence rates. Patients presented to the hospital mostly in severe uremia and without a clear history of prior medications. The major findings were vomiting, acidosis, and hypertension with serum creatinine values ranging between 2.8-45 mg/dL (mean value, 13.4 mg/dL). Anemia was observed in 80.4% of CRF versus 62.6% of ARF patients. Hypertension prevalence was 65.5% among CRF patients, of whom 25% were in hypertensive crisis, whereas among ARF the prevalence was only 26.5%.     

Epidemiology of chronic renal failure in children: a report from Sweden 1986 – 1994

In a national survey, chronic renal failure (CRF) in Swedish children was studied during the period 1986 – 1994; 118 children (72 boys, 46 girls) with CRF, defined as a glomerular filtration rate below 30 ml/min per 1.73 m² body surface area, were identified. The median annual incidence of CRF was 7.7 and that of terminal renal failure (TRF) 6.4 per million children. The prevalence of preterminal renal failure decreased from 29 to 21 per million children over the study period, while the prevalence of TRF increased from 17.8 in 1986 to 38 per million children in 1994. The increase in TRF prevalence was due to a lower incidence of deaths due to uremia and a slightly increased incidence of TRF compared with an earlier study period, 1978 – 1985. The results point to a more active treatment of uremia in Sweden now than during the period 1978–1985. The congenital causes of CRF (renal malformations, obstructive conditions, and hereditary disorders) accounted for 67.5% of all cases, which is high compared with data from other countries. No child with non-obstructive pyelonephritis as a cause of CRF was identified. Age at detection of CRF and time from detection of CRF to TRF were studied. As a high proportion of children, 42%, reached 16 years of age without entering TRF, the value of presenting time from CRF to TRF for the remaining individuals is questionable. There were only minor differences in primary renal disease, age at presentation, and time from CRF to TRF when the study results were compared with those from 1978 – 1985. Received October 1, 1996; received in revised form and accepted January 21, 1997     

Children with chronic renal failure in Sweden 1978–1985

A survey of chronic renal failure (CRF) in Swedish children was carried out for the period 1978–1985, using age-related cut-off levels for creatinine concentrations corresponding approximately to a glomerular filtration rate of 30 ml/min per 1.73 m². The mean annual incidence of CRF was 6.9 and of terminal renal failure (TRF) 4.4/million children. The prevalence increased during the study period, for preterminal renal failure from 14.1 (1978) to 26.1 (1985) and for TRF from 12.4 to 16/million children. The main groups of primary renal disease were malformations (42%), hereditary disorders (27%), and glomerular diseases (14%), while pyelonephritis with vesico-ureteral reflux only made up 5%.     

Chronic renal failure in Kuwaiti children: an eight-year experience

Over an 8-year period (January 1996 to December 2003), a total of 171 patients below the age of 15 years were diagnosed with chronic renal failure. The mean incidence rate of CRF in Kuwaiti children was found to be 38.2 per million children per year, with a peak incidence of 55 per million children per year. While the mean age at diagnosis was 33±12 months (range: 1 month to 15 years), the male:female ratio was 2.7:1. Etiological factors for chronic renal failure included congenital urological malformation (61.9%), chronic glomerulopathies (5.2%), hereditary nephropathies (21%), multi-system disease (0.5%), chronic pyelonephritis (without VUR) (4.6%), tumors (0.6%), ischemic renal disease (1.1%) and unknown etiology (1.7%). Thirty percent of patients reached end-stage renal disease within a mean of 18 months following diagnosis. The overall mortality before reaching ESRD was reported to be 4%. Kuwait has one of the highest incidence and prevalence rates of CRF in children. It is likely that genetic and hereditary factors are the cause of these high rates.     

Chronic renal failure in children: a report from Port Harcourt,Nigeria (1985–2000)

A 15-year review of children who presented with chronic renal failure (CRF) to the University of Port Harcourt Teaching Hospital, Rivers State of Nigeria, was carried out. Forty-five children (28 boys, 17 girls) with CRF, defined as a glomerular filtration rate below 30 ml/min per 1.73 m(2) body surface area or a rise in serum creatinine above 120 micro mol/l for at least 6 months, often accompanied by other biochemical abnormalities, were identified. The median annual incidence of CRF was 3.0 per million children. The prevalence of CRF increased from 12.5 in the 1985-1990 periods to 15 per million children after 1995. Acquired disorder was the major cause of CRF. Glomerulopathies were the cause in 53.3% of patients, mainly chronic glomerulonephritis (56.5%) and nephrotic syndrome (30.4%). Hepatitis B surface antigen was positive in 2 patients. Congenital disorders accounted for 28.9% of all cases of CRF, which is lower than data from other countries. Posterior urethral valve was the only congenital disorder causing CRF in the study. No child with hereditary renal disorder as a cause of CRF was identified. Children with congenital disorders were diagnosed at an earlier age. The mortality rate was high (46.7%), as most patients were managed conservatively, since there were no permanent facilities for chronic dialysis or renal transplantation in Nigeria. The study shows that CRF is common in Nigerian children, and there is an urgent need for the establishment of facilities for renal replacement therapy.     

The spectrum of chronic renal failure among Jordanian children

BACKGROUND: The causes of chronic renal failure (CRF) vary from one country to another. In this study we reviewed our experience with the different types of renal disorders leading to CRF in Jordanian children. METHODS: We investigated CRF in 202 Jordanian children (113 males and 89 females) who presented to the Jordan University Hospital, Amman, in the period from July 1988 to April 2001. The mean age at onset of CRF was 7.5 +/- 3.9 years. Patients were followed for 0.6-12.6 years (mean 6.3 years). RESULTS: The causes of CRF included urological abnormalities and malformations (42.1%), hereditary renal disorders (29.7%), glomerulonephritis (GN)(14.4%), renal hypo- or dysplasia (5%), hemolytic uremic syndrome (HUS) (4.5%), and idiopathic (4.5%). Forty-nine patients required renal replacement therapy, most of them with peritoneal dialysis. Nine patients have undergone renal transplantation. We estimated the prevalence of CRF in children in Jordan to be 51 per million population, and the incidence as 10.7 new cases per million-child population per year. CONCLUSION: The high rate of hereditary disorders in our series is attributed to the high prevalence of parental consanguinity in our community. There was a striking number of patients with non-neurogenic neurogenic bladder in our study. The relative incidence of GN leading to CRF in Jordan is lower than in Europe and North America. The relative incidence of the other causes of CRF in our series is similar to many other countries. The incidence and prevalence of CRF in children in Jordan is high compared to other countries.     

Early prognostic factors of infants with chronic renal failure caused by renal dysplasia

Renal dysplasia (RD) is a common cause of chronic renal failure (CRF) in children. The evolution towards end-stage renal failure is unpredictable due to the paucity of early prognostic factors. In order to identify early prognostic clinical criteria, we have retrospectively analyzed renal function and growth in 11 infants with RD and CRF from birth up to 4 years of age. Children with obstructive RD were not included. Glomerular filtration rate (GFR) was estimated from Schwartz formula. In infants with a GFR below 15 ml/min per 1.73 m² at 6 months of age (group A, n=5), kidney function did not further improve; 4 reached end-stage renal failure between 8 months and 6 years of age. In contrast, infants with a GFR above 15 ml/min per 1.73 m² at 6 months of age (group B, n=6) experienced a significant improvement in renal function during follow-up, and none required renal replacement therapy. During the first 3 months of life all infants with RD and CRF developed severe growth retardation. Between 6 months and 4 years of age, children from group B grew significantly better than those from group A. In conclusion, our experience suggests that GFR, estimated from Schwartz formula at 6 months of age, is a useful prognostic factor in infants with RD and CRF. Infants with a GFR below 15 ml/min per 1.73 m² are at risk of severe growth delay and the need for early renal replacement therapy, whereas those with a GFR above 15 ml/min per 1.73 m² have a relatively favorable long-term prognosis. Received: 4 October 1999 / Revised: 26 October 2000 / Accepted: 26 October 2000     

Chronic renal failure in pediatrics 1996

 The Nephrology Branch of the Chilean Pediatric Society has greatly influenced the development of government health plans regarding the management and care of patients under 18 years with chronic renal failure (CRF). In order to assess the status of children with CRF in Chile up to 1996, a questionnaire was sent to all pediatric nephrologists in charge of those children. The total sample was of 227 patients under 18 years, giving a national prevalence of 42.5 and an incidence of 5.7 per million inhabitants; of these patients, 50.7% were male, 58.6% over 10 years and 15% younger than 5 years. The most frequent etiologies of CRF were: obstructive uropathy, 18.1%; hypo/dysplasia, 16.7%; reflux nephropathy, 16.7%; and glomerulopathies, 16.3%. Although 48% of patients were on conservative medical treatment, 42.2% of these were in end-stage renal disease, 22.9% were on dialysis, and 29.1% had undergone renal transplantation. Of the dialysis group, 75% were on peritoneal dialysis. Of the transplanted children, 78.8% had normal renal function, but 16.7% returned to dialysis. Three-year graft survival and patient survival were 68% and 94%, respectively. Received: 19 January 1998 / Revised: 6 July 1998 / Accepted: 16 July 1998     

Etiology of sustained hypertension in children in the Southwestern United States

We reviewed the records of 132 children with persistent hypertension who were evaluated by our pediatric nephrology services between 1987 and 1991. Eightynine (67%) of these children were found to have renal or renovascular disease, 30 (23%) had primary hypertension and 13 (10%) had a non-renal cause for their hypertension. Glomerulonephritis (n=37) and reflux nephropathy (n=26) were the most frequent renal disorders identified. Renal artery thrombosis was the most common cause of hypertension in the neonatal period (in 6 of 12 neonates, 50%) whereas cystic kidney disease was the most common cause of hypertension in the 1st year of life (in 9 of 30 infants, 30%). The prevalence of primary hypertension increased with age; this diagnosis was made in 16 of 46 (35%) hypertensive patients between 12 and 18 years of age and, more surprisingly, in 8 of 27 (30%) children between 7 and 11 years of age. These data confirm that secondary hypertension is the most common cause of hypertension in children but suggest that primary hypertension is more prevalent than previously recognized in patients between 7 and 18 years of age.