Juvenile systemic lupus erythematosus in Bahrain. A tertiary referral center experience

To analyze the clinical and serological features of children with systemic lupus erythematosus [SLE] in a major referral center in Bahrain and to assess the comorbidity, its morbidity, and mortality. We retrospectively reviewed the medical charts of children with SLE treated in the Pediatric Rheumatology Clinic at Salmaniya Medical Complex, Kingdom of Bahrain from 1998 to 2007. The ethical approval for the study was obtained from the Research Health Committee, Ministry of Health, Kingdom of Bahrain. Thirty-two children with SLE were identified. Thirty-one [96.8%] were Bahrainis. The mean age was 14 +/- 4 years, the mean age of disease onset was 9 +/- 4 years and the mean duration of illness was 7 +/- 5 years. The female to male ratio was 2.5:1. Twenty-five percent of the cases had relatives with SLE. Eight patients [25%] had sickle cell anemia [SCA]. Systems involved were as follows: skin [93%], kidney [81%], musculoskeletal system [65%], blood [56%], gastrointestinal tract [31%], central nervous system [31%], lungs and cardiovascular system [21%]. Serological tests showed: positive antinuclear antibody in 90.6%, and positive anti double-stranded DNA antibody in 65%. The morbidity rate was 21% [n=7] due to complication and 12.5% [n=4] died. Clinical and serological results were comparable with the international studies. Nephritis was the primary cause of morbidity and mortality. Coexistence of SLE with SCA was also reported in other studies and may need further investigation with genetic studies

Diabetic nephropathy in children with type 1 diabetes mellitus in Bahrain

Children and adolescent patients with type 1 diabetes mellitus [T1DM] may have an increased risk of developing diabetic nephropathy [DNP]. The incidence of DNP varies with glycemic control, and peaks after 15-20 years of diabetes and decline thereafter. Microalbuminuria is uncommon before puberty, and usually occurs after 5 years of diabetic duration. Once overt DNP is established, a progressive decline in the glomerular filtration rate and elevation in arterial blood pressure occurs, and it is the most important disorder leading to renal failure in adult patients with diabetes in developed countries. The purpose of this study was to screen all the children and adolescent with T1DM of 5 years duration or more for DNP. Between April 2000 and February 2001, all patients with T1DM of more than 5 years, who were diagnosed between years 1985 to 1995 and followed by pediatricians at Salmaniya Medical Complex, Kingdom of Bahrain, were screened for DNP. Medical records were reviewed for demographical data, blood for hemoglobin A1c [HbA1c], fasting sugar and renal function test. The presence of DNP, retinopathy and neuropathy and the medications were also reviewed. DNP was diagnosed by urine microscopy, overnight urine collection for albumin to creatinine ratio, or 24-hour urine for protein, and the medications Diabetic nephropathy was diagnosed in 10 patients [31%], 2 with microalbuminuria [incipient nephropathy], and 8 with proteinuria [clinical nephropathy]. Diabetic nephropathy was diagnosed at a mean of 10.5 years after the onset of T1DM. The mean age was 18 years for the DNP. Mean HbA1c was 11.8% for DNP and 10.2% for non-nephropathy group. All the patients with DNP were treated with an angiotensin converting enzyme inhibitor, 5 of them had hypertension. None developed renal failure or retinopathy. Microalbuminuria is uncommon before 5 years of the onset of T1DM. Screening for microalbuminuria should be performed in adolescent over 12 years of age, with diabetes of more than 5 years duration and persistent hyperglycemia [HbA1c > 11%]