ABSTRACT
OBJECTIVE: The purpose of this study was to find out the aetiology of end-stage renal failure (ESRF) in children in Jordan. SUBJECTS AND METHODS: This was a multicentre retrospective study at five participating hospitals. Data collection included medical record review for age, gender, aetiology of ESRF, modality of renal replacement therapy (RRT) and outcome. End-stage renal failure was defined as estimated glomerular filtration rate < 15 mL/min/1.73m2. RESULTS: There were 275 children with ESRF: 131males and 144 females. The most common causes of ESRF in children were congenital anomalies of the kidney and urinary tract (CAKUT), 45.8%, heredofamilial disorders, 23.2% and glomerulopathies, 26.2%. Neurogenic bladder, reflux nephropathy and posterior urethral valve accounted for 16.8%, 12.7% and 4.0%, respectively. Amongst the heredofamilial disorders, primary oxalosis and cystic disease accounted for 8.0% and 7.2% of the aetiologies of ESRF, respectively. Focal segmental glomerulosclerosis was the most common histological type amongst the glomerulopathies (10.2%), followed by mesangiocapillary glomerulonephritis (4.7%) and chronic glomerulonephritis (3.0%). The aetiology was unknown in 4% of the cases. The modality of dialysis included isolated peritoneal dialysis (PD) in 30.9%, isolated haemodialysis (HD) in 49.1%, alternating peritoneal and haemodialysis in 9.1%, transplanted in 8.7% and conservative treatment in 1.8%. Death occurred in 57.3% of PD patients versus 34.4% in HD patients. CONCLUSIONS: This is the first report on the aetiology of ESRF in children in Jordan. The most common aetiologies of ESRF were CAKUT 45.8%, heredofamilial disorders 23.2% and glomerulopathies 22.9%.
ABSTRACT
This study was undertaken to compare "direct" and "indirect" nuclear cystography for the detection of vesicoureteral reflux (VUR). Forty-five children (15 males and 30 females), ranging in age from 5 months to 10 years, were studied at the King Hussein Medical Center, Amman, Jordan between January 1998 and December 1999, using both direct (catheter) and indirect techniques of nuclear cystography (NC). Of the 82 ureters that could be compared, 32 ureters were positive for VUR on the direct technique while only 20 ureters showed VUR on the indirect technique (sensitivity 62%). Nine ureters, which did not show VUR on the direct cystogram, were read as positive on the indirect cystogram (specificity 82%). The false positive results of indirect nuclear cystogram make it invalid for VUR screening program, while the ease of assessment and low radiation dose from the direct NC has made this the recommended test for screening and follow-up of VUR.
ABSTRACT
This is a retrospective study designed to find out the clinical profile of children with Wilms' tumor admitted to King Hussein Medical Center over a 6.5-year period. There were 26 patients (eight males and 18 females) with a median age of three years (range 1-8 years), at the time of diagnosis. Twenty children went into complete remission for a period ranging from 4-80 months (mean 46 months). Six children relapsed locally or with distant metastasis. All the six children with relapse died because of progressive disease. The overall relapse free survival was 77% for all stages (100%, 90%, 66.6%, 0% and 100% for stage I, II, III, IV and V respectively). This is similar to the international figures for stage I & II but is still behind for stage III & IV.
ABSTRACT
Wolfram's syndrome is usually considered as an autosomal recessive condition, with wide phenotypic variation. The syndrome is commonly called DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness), although some patients have additional clinical findings including ataxia, hypogonadism, hydronephrosis and psychiatric illnesses. We report a patient with DIDMOAD syndrome with emphasis on the urological tract and its progressive complications. Unfortunately, he developed end-stage renal failure and needed hemodialysis at the age of 14 years. The presentation, investigations and management are discussed.
ABSTRACT
Galloway-Mowat Syndrome (GMS) has a wide variety of clinical manifestations and histologic findings. All reported cases had developed nephrotic syndrome in the first two years of life. We report a case of 12 years old boy with microcephaly, mental retardation, and typical dysmorphic features of GMS with a late onset of minimal change nephritic syndrome which first manifested at seven years of age.
ABSTRACT
A nine-year-old male child with acute renal failure complicating serologically proven non-fulminating hepatitis A virus infection is being reported. This is rare complication. The patient required dialysis for two weeks and recovered completely with the return of his laboratory tests back to normal.
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We report a case of a child with symptoms and signs of Bartter's syndrome and nephrocalcinosis. This report discusses the manifestations and management of this rare disease at a very early age.
ABSTRACT
A prospective field study was conducted to determine the prevalence rate of cryptorchidism, hypospadias and other genital disorders in school children in the eastern part of Jordan. A total of 2495 school boys from 10 different schools were examined in May-June, 1995. Standardized examination and classification criteria were used. Two general practitioners and two pediatricians carried out the study. The various genital disorders detected during the screening were as follows: Undescended testis, 1.96%; Inguinal hernia, 0.80%; Varicocele, 1.08%; Hydrocele, 0.52%; Hypospadias, 0.92%. The prevalence rates of genital disorders in this study were similar to those reported by others. Early recognition and treatment of genital disorders in school children is mandatory in order to prevent potentially adverse effects.
ABSTRACT
A prospective study was carried out over a three-year period (1993-95) on 4469 school children drawn from 20 different schools in rural areas of Jordan. There were 2592 males and 1877 females aged between 6-16 years. The height, weight, systolic and diastolic blood pressure (BP) were recorded for both sexes followed by complete clinical examination. The BP was recorded according to the criteria laid down by the second task force on BP in children, using mercury sphygmomanometers, in sitting position and in the right arm. Data were analyzed and the percentiles were calculated for each age-group in both sexes. Both systolic and diastolic BP had positive correlation with age, height, weight and body surface area. There were no differences in the systolic BP for both sexes of corresponding age, while there was a difference in the diastolic. The upper limits of normal, 90th percentile, systolic/diastolic pressures were 116/76, 122/80, 128/81 and 139/86 in children aged 6-8 years, 9-11 years, 12-14, and 15-16 years respectively, with prevalence of 13.35% (n = 596). The lower limits of hypertension, 95th percentile, for systolic/diastolic pressures were 122/81, 126/83, 134/84, and 142/88 mm Hg in each of the same age-groups respectively, with prevalence of 6.85% ( = 306), while for severe hypertension, 99th percentile, for the same age-groups the values were 131/86, 134/87, 145/89 and 154/90 mm Hg respectively, with prevalence of 1.95% (n = 87). The findings in this study were consistent with international data. We emphasize the need for regular check up of BP in our children. Also, further studies are necessary including other areas of Jordan and smaller age-group children.
ABSTRACT
To evaluate the presence of vesico ureteric reflux (VUR) and renal scarring in children with documented symptomatic urinary tract infection (UTI), and the importance of age at time of presentation, we studied 29 patients with UTI. Nineteen patients were females and 10 were males. Three patients were below one year of age, 13 were between one and five years, and 13 were above five years. None of the patients had systemic hypertension or renal insufficiency. All patients had renal ultrasound and renal scintigraphy with dimercapto succinic acid (DMSA). Micturating cystourethrogram was done in all children below age of five, and in patients above age of five if renal scintigraphy showed evidence of scarring. Of the 29 UTI patients 10 (34%) had VUR. Of the patients with VUR, seven were below age of five while three were above five. Renal scarring was found in 3/7 patients with VUR below age of five years, but was in all patients with VUR above age of five years. All patients with grade 3 and 4 reflux nephropathy had renal scarring, while it was found in half of the patients with grade 1 and 2 reflux. We conclude that in UTI patients VUR is not uncommon finding, which needs further investigations and follow-up.
ABSTRACT
Case records of patients aged 13 years or below with chronic renal failure (CRF), seen during the last 10 years at the King Hussein Medical Center, Amman, Jordan were reviewed. There were 46 patients with CRF, (25 males and 21 females), aged 1/2 to 13 years. Chronic pyelonephritis was the major cause of CRF seen in 23 cases (50%), followed by glomerulonephritis in eight (17.4%), congenital hypodysplasia in six (13%), hereditary nephritis in five (10.9%) and unknown etiology in four (8.7%). Of the study patients, 17.3% were below the age of five years at first presentation. Twenty one patients progressed to end-stage renal disease and among them chronic glomerulonephritis was the most common primary renal disease. The higher incidence of chronic pyelonephritis causing CRF in our series in comparison to 23.9% incidence reported in the developed countries shows that our infants and young children probably are not investigated early enough nor do they receive adequate treatment at the time of their first urinary tract infection. Prevention of renal failure, availability of replacement therapy, and extension of treatment opportunities to more children are the main problems concerning CRF in children in our country.
