Predictors of renal replacement therapy and mortality in children with chronic kidney disease

To study the epidemiology of chronic kidney disease [CKD] in children, and to look for risk factors to predict renal replacement therapy [RRT] and mortality. This is a retrospective cohort study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 2006 and 2014, where the files of 1,000 children with CKD were reviewed. We determined the effect of consanguinity and hypertension, and being a Saudi indigene on mortality and RRT. We compared children with congenital versus non-congenital causes of CKD. The mean +/- standard deviation age at presentation was 4.9 +/- 4.3 years. The median duration of follow up was 1.5 [interquartile range [IQR]: 0.4-4.0] years. Only 9.7% of children received RRT, and 8.3% died. The underlying etiology for CKD was congenital in 537 children. The congenital CKD group presented at a younger age group [3.5 +/- 4.0 versus 6.6 +/- 3.9 years, p<0.0001], had more advanced stages of CKD [p<0.0001], higher rates of consanguinity [75.4% versus 47.1%, p<0.0001], and RRT [p<0.004] than children with non-congenital CKD. Risk factors for RRT among children with CKD include being a Saudi indigene [relative risk [RR]=1.49, 95% confidence interval [CI]: 1.01-2.21], and hypertensive [RR=5.29, 95% CI: 3.54-7.91]. The risk factor for mortality was hypertension [RR=2.46, 95% CI: 1.66-3.65]. Congenital causes of CKD represent the main etiology of CKD in children living in the western province of Saudi Arabia. Significant risk factors for RRT include congenital CKD, Saudi nationality, and hypertension. Hypertension is also a predictor of mortality in children with CKD

Renal artery stenosis in association with congenital anomalies of the kidney and urinary tract

To describe 8 cases of renal artery stenosis [RAS] in children with congenital anomalies of the renal tract. We conducted a retrospective chart review of 78 children with RAS who were followed up at Great Ormond Street Hospital, London, United Kingdom between 2003 and 2012. We used an interventional radiology database to identify all patients who had RAS confirmed by digital subtraction angiography and examined all cases of congenital anomaly of the renal tract that had been diagnosed during childhood. We documented the following renal anomalies: multicystic dysplastic kidney [n=2], renal hypoplasia [n=1], congenital solitary kidney with hydronephrosis [n=1], and unilateral vesicoureteric reflux with poorly functioning kidneys [n=2]. The anomaly was unknown in 2 cases. Seven children had unilateral nephrectomy at a median age of 2.5 years [range, 0.4-10 years] for various urological abnormalities. All children were confirmed to have RAS after presentation with hypertension at a median age of 10 [3.5-16.2] years. Angioplasty was performed in 7 children, of which 6 achieved control of their blood pressure on reduced medications. We highlight the association between RAS and other renal anomalies, which indicates that they could share a common genetic background

Vesicoureteric reflux in children

This study aimed to identify the differences between primary and secondary vesicoureteric reflux [VUR] and the effect of associated bladder abnormalities on kidney function. We retrospectively reviewed the medical records of children with VUR who were followed up at King Abdulaziz University Hospital from January 2005 to December 2010. The review included results of radiological investigations and kidney function tests. We used Chi-square test for statistical analysis and paired t-test to compare group means for initial and last creatinine levels. Ninety-nine children were included in this study. Twenty [20.2%] had primary VUR, 11 had high-grade VUR, while 9 had low-grade reflux. All children with low-grade VUR had normal dimercaptosuccinic acid [DMSA]. Renal scars were present in 72% of the children with high-grade VUR. The mean creatinine levels [initial and last] for both groups were normal. Seventy-nine [79.8%] children had secondary VUR, which was due to posterior urethral valves [PUV] [46.8%], neurogenic bladder caused by meningomyelocele [25.3%], non-neurogenic neurogenic bladder [NNB] [21.5%], or neurogenic bladder associated with prune belly syndrome [6.3%]. Children with NNB, meningomyelocele and PUV had high creatinine at presentation with no considerable worsening of their kidney functions during the last visit. Renal scars were present in 49.4% of the children with secondary VUR. Children with primary VUR and normal bladder had good-functioning kidneys, while those with secondary VUR associated with abnormal bladder caused by NNB, spina bifida or PUV had abnormal kidney functions. DMSA scans were useful in predicting higher grades of VUR in children with primary reflux

Quality of life among children with beta-thalassemia major treated in Western Saudi Arabia

To assess the quality of life among children and adolescents with thalassemia major. This cross-sectional study used the Pediatric Quality of Life Inventory [PedsQL]. Children and adolescents with beta-thalassemia major who attended the Day Care Unit at King Abdulaziz University Hospital, Jeddah, Saudi Arabia from October 2012 to February 2013 were surveyed. The questions highlighted 4 health status scales, namely physical functioning [PF], emotional functioning [EF], school performance [SC], and social functioning [SF]. Scores were calculated for each patient and data were analyzed using the Statistical Package for Social Sciences. We recruited 46 children [60.9% males]. The median age of the sample was 12 years [range, 2-18 years]. Most patients [84.8%] had 3 weekly blood transfusions. The mean +/- SD physical functioning [PF] score was 57.2 +/- 25.9; the EF score was 74.1 +/- 20.3, SF score was 78.5 +/- 24, and SC score was 54.3 +/- 24.2. The PF score was significantly lower in patients with a family history of thalassemia [p=0.003], and in those whose families had low incomes [p=0.049]. Conversely, the SF score was significantly higher in school-educated patients [p=0.01]. The quality of life of thalassemic children is affected by multiple factors, such as family income and a family history of thalassemia. Education appeared to increase patient functionality. Supportive measures could improve the quality of life in thalassemic patients

Vitamin D insufficiency and treatment with oral vitamin D3 in children with chronic kidney disease

To investigate the effects of oral cholecalciferol on the levels of vitamin D3 and intact parathyroid hormone [iPTH] in children with chronic kidney disease [CKD]. We conducted a prospective uncontrolled observational study at the Pediatric Nephrology Clinic of King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia between January and October 2011 to assess serum 25-hydroxyvitamin D3 [25[OH]D] and iPTH in children with CKD stages 2-5. Children with low vitamin D3 levels were commenced on cholecalciferol, 2000 IU/day. Their 25[OH]D3 and iPTH levels were reassessed, first after 3 months, then after 6 months. Data analysis was performed using the Statistical Package for Social Sciences. Paired t-test was used to compare results before and after treatment. Forty-five children [31 boys and 14 girls] were included in the study. Their mean +/- SD age was 9.6 +/- 4.6 years. There was significant improvement in 25[OH]D3 after 3 months [14.2 +/- 8.2 - 20 +/- 11.1 ng/mL] [p<0.001]. However, only 5 children reached levels >/= 30 ng/mL. There was no further improvement after 6 months of treatment [20.17 +/- 13.4 ng/mL] [p=0.65]. There was no improvement in iPTH levels after 3 and 6 months. No changes were also observed in the levels of calcium, phosphate, alkaline phosphatase, or creatinine. The administration of oral vitamin D3 at 2000 IU/day resulted in significant improvement of vitamin D levels in children with CKD, but normalized only in 11% of the patients. The treatment had no effect on iPTH levels

Folic acid awareness among female college students. Neural tube defects prevention

To investigate the level of awareness among female college students on the importance of preconception folic acid supplementation in preventing neural tube defects [NTDs]. We have also studied their response after educating them. This is a questionnaire-based study. Five hundreds questionnaires were distributed to the female students of the 3 colleges, namely, Humanities, Sciences, and Health in Jeddah, Kingdom of Saudi Arabia in April 2008. The questions included an enquiry on their knowledge regarding the importance of folic acid preconception, and if they will implement what they learned after listening to lectures, delivered by the 4th year medical students, who were trained and supervised by the faculty members of the King Abdul-Aziz University. Two hundred and seventeen questionnaires were filled, and returned [43.4%]. Mean age +/- SD was 20.96 +/- 2.25 years. Almost 88% were not aware of the importance of folic acid in preventing NTDs. After listening to the lecture, 82.9% thought that they will surely use folic acid preconception, and 98.6% will relay the important message about the importance of folic acid to others. There is a need to increase the awareness of the importance of folic acid among females' childbearing age. Medical students' involvement in educating college students was an effective way to increase their awareness. Similar educating programs are required, in order to reduce the high incidence of NTDs

Neuropathic bladder as a cause of chronic renal failure in children

A retrospective study of all paediatric cases diagnosed as neurogenic bladder and presented with chronic renal failure [CRF] [GFR <50 ml/minute/1.73 m2] from December 2000 to December 2004. Fifteen patients were diagnosed as neuropathic bladder. Group A included nine spina bifida and one sacral agenesis cases and group B included four non-neurogenic neurogenic bladder [NNNB] cases. The mean age +/- SD at presentation was 6.2 +/- 3.8 years, GFR level was 24.2 +/- 12.4 ml/minute/1.73 m2 and creatinine level was 289.9 +/- 253.2 mumol/l. There was no difference in the age of presentation to paediatric nephrologist or the degree of renal failure at presentation between the two groups. All children with NNNB in group B presented with recurrent urinary tract infection [UTI] and the two older children were also reported as wet during the day. Clean intermittent catheterization [CIC] was not started in all patients before presentation to KAUH, except in two children, in whom it was started by urologists. Five children required dialysis, as they were in end stage renal failure [ESRF]; four in group A and one in group B. All cases, except one, received peritoneal dialysis [PD]. Their mean age at the start of dialysis was 10.8 +/- 1.7 years. Two children with shunted hydrocephalus were dialyzed peritoneally; one of them had peritonitis and complicated with a Staph. epidermis shunt infection; therefore this case was shifted to haemodialysis and required externalization of the V-P shunt for few weeks. Only one patient was started on haemodialysis from the start due to social reasons

Early presentation membranoproliferative glomerlonephritis in Arab Children

Idiopathic membranoproliferative glomer-ulonephritis [MPGN] is a relatively uncommon cause of progressive renal disease characterized by immune complex deposition resulting in mesangial proliferation and endocapillary inflammation with capillary wall thickening. It has a variable clinical expression and usually thought of as a disease of older children and young adults. In this study we report the spectrum of MPGN in Arab children. Eight Arab patients with MPGN type I and type II were described and studied retrospectively. This study was carried out at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia during a 6 year period, 1996-2002. Their mean age at presentation was 2.4 +/- 1.2 years. All patients presented with a steroid resistant nephrotic syndrome. None had macroscopic hematuria. However 5 [62.5%] were hypertensive at presentation. Complements were low in 3 patients [37.5%]. The mean follow-up between presentation and last visit was 1.1 +/- 0.7 years; range 0.1-2. Three patients were siblings and their parents were 2nd-degree cousins. Another patient had a brother who had a renal failure following steroid resistant nephrotic syndrome [SRNS], but the histological cause of his SRNS was not known. Four patients were on dialysis within 2 years of follow-up, one patient progressed to chronic renal failure with creatinine of 240 umol/l, one patient died and 2 patients were lost follow-up. Membranoproliferative glomerulonephritis seems to present at earlier age in Arab children and tends to have a severe course with rapid progression to end stage renal disease