Glomerulonephritis in children: experience from the Kuwait renal centers

To study the clinical, pathological, and epidemiological features of childhood steroid-refractory idiopathic glomerulonephritis [SRIGN], i.e., nephrotic syndrome, which failed an 8-week course of prednisone, and secondary forms of glomerulonephritis [GN] in Kuwait. Data on these two forms of GN were collected retrospectively from the records of children attending the two renal centers of Kuwait between January 1, 1990, and December 31, 1996. During the 7 years, a total of 80 children were diagnosed to have GN, 56 of whom were Kuwaiti nationals. In the latter group, 34 children had SRIGN. Hence, the calculated annual incidence rate of Kuwaiti children with both GNs was 3.1 per million and that for SRIGN was 1.9 per million children. Histologically, 22 [65%] of these patients had minimal change, 5 [16%] focal segmental, 2 [6%] non-IgA mesangioproliferative, and 1 membranous GN. Congenital nephrotic syndrome, membranoproliferative GN, and GN secondary to parasitic infestations or microbial infections were not seen in the Kuwaiti children, and nephrotic syndrome secondary to IgA glomerulopathy was diagnosed in 1 patient only. Aggressive autoimmune diseases such as systemic lupus erythematosus [SLE] and vasculitis were common. Seven patients had SLE which accounted for 44% of secondary GN and for 14% of all the patients included in the study, while 3 patients were found to have vasculitis. Interestingly, only 3 of the 13 patients with SLE and vasculitis presented with rapidly progressive GN. Conclusions: The pattern of renal disease associated with SRGN in Kuwaiti children is different from that reported from neighboring countries and other Arab states. The homogeneity of the population studied, lack of endemic infections or parasitic infestations, and genetic predisposition may have been the underlying factors. Furthermore, the high incidence of the insidious kidney-limited disease associated with SLE and vasculitis is another feature which indicates a more aggressive diagnostic approach in the management of GN in our area

Spongiform encephalophathies [SE]: transmissible or neurodegenerative diseases

Spongiform encephalopathies [SE] are a group of disorders of the central nervous system which affects both animals and humans. These disorders include Creutzfeldt-Jacob disease [CJD], Gerstmann-Strassler-Scheinker syndrome [GSS], Kuru, Scrapie, bovine SE and others. These various entities are linked by characteristic pathology which include; spongiform change, neuronal loss and astrocytic gliosis as well as prolonged incubation period often extending to years and the possibility of sharing the same transmissible agent/s. In this article, the most recent data on SE disease is reviewed and especially its link to humans

Kidney transplantation after the Iraqi invasion

Since the last issue of the JKMA, major achievements have been made in the field of Kidney transplantation in Kuwait. By June 1996, a total of 56 patients had already received kidney transplantation, 10 of whom had received cadaveric kidneys harvested locally. These achievements were the results of dedicated efforts by the local transplant team and co-ordinators and are a reflection of the co-operation of anaesthetists in the different intensive care units in Kuwait, as well as the continuous support and confidence of the Ministry of Health

Urinary electrolytes: uses and limitations

Disturbances of the volume and composition of body fluids are frequent manifestations of a wide variety of disease processes, and they often dominate the clinical picture. Some of the direct result of a primary disease originating in the kidney itself or involve it as a complication of diseases arising elsewhere, while others are inadvertent consequences of our therapeutic interventions. No matter what their origin, these changes represent formidable potential threats to our patient's health and demand careful and thoughtful correction. This article is designed to provide an outline for a rational use of urinary electrolyte estimation in assessment of some common water and electrolyte disorders, their limitations and more importantly the specific pre-requists for their interpretation