Spectrum of renal bone diseases in Sudanese children with chronic renal failure

ABSTRACT

Disturbance in mineral and bone metabolism are common in children with chronic kidney disease [CKD]. A large body of evidence indicates that renal osteodystrophy [ROD] affects skeletal growth and development and may result in increased morbidity and mortality. The purpose of this study is to determine the prevalence and types of ROD and to study the clinical and radiological manifestations of ROD. This is a cross-sectional survey of children with chronic renal failure in 5 main dialysis centers in Khartoum state. A designed questionnaire was conducted for data collection including personal details, social and dietary history, dialysis history and prescriptions, growth parameters, diagnosis, clinical picture, investigations and management. The study included 57 children with chronic renal failure [CRF] of whom the majority [75.4%] reached end stage renal failure [ESRD]. The cause of renal failure was undetermined in 28 patients [49.1%]. The mean duration on dialysis was 14 months. The majority of children [n=22] [44.8%] had moderate growth impairment. Renal osteodystrophy was documented in 36 patients [63.9%]. The most common clinical presentation of ROD were bone pain, joint pain and pruritis, they accounted for 58.8%, 52.9% and 52.9% respectively. The most common radiological findings were osteopenia [88.8%], subperiosteal bone resorption [72.2%] and delayed bone age [69.4%].The predominant pattern of ROD was secondary hyperparathyroidism [2ry HPTH] [52.6%]. Renal osteodystrophy is a common complication in Sudanese children with CRF with the predominance of secondary hyperparathyroidism. The management of children with CRF should be in a paediatric nephrology unit through a multidisciplinary team approach and the treatment should be individualized