SPECTRUM OF CHRONIC RENAL FAILURE King Hussein Medical Center Edward Saca MD, MSc

Introduction Rare in children when compared with adults Significant cause of morbidity and mortality in the pediatric age group  Developing countries Early identification and management  Main concern of pediatric nephrologists  Recent advances of RRT Pediatric renal transplantation

Introduction Data defining pediatric renal failure in Jordan ???  Etiology  Incidence  Prevalence Absence of a national registry system Absence of a regional registry system In this study we define  Etiology of pediatric CRF at KHMC  Prevalence of pediatric CRF in Jordan  Demographic features of CRF at KHMC Fair reflection of pediatric CRF in Jordan

Procedures and Methods Registry analysis done at KHMC All children with CRF and a calculated GFR < 80 ml/min/1.73m 2 who presented to the OPD during the year 2004 were included in the study Children with ESRD on dialysis or who were transplanted were also included Patients were registered over a one year period starting January 2004 and ending December 2004  Age and gender  Cause of CRF (primary diagnosis)  Serum creatinine at the time of recording  Height  Duration of follow up  Dependency status  Outcome

Procedures and Methods GFR was calculated for all patients based on serum creatinine and height  Schwartz formula Patients were grouped into four stages according to the KDOQI guidelines  MildGFR 60 – 89 ml/min/1.73m 2  ModerateGFR 30 – 59 ml/min/1.73m 2  SevereGFR 15 – 29 ml/min/1.73m 2  ESRDGFR < 15 ml/min/1.73m 2

Procedures and Methods Prevalence  35% of the population in Jordan are covered by RMS Population in Jordan 5.5 million Pediatric population 50% (2.75 million) Pediatric population covered by RMS0.96 million  All children with CRF in hospitals related to the RMS are referred to KHMC  For accuracy children followed up in the pediatric nephrology clinic and are not covered by the RMS were excluded when prevalence was calculated

Procedures and Methods The duration of follow up was calculated from the time the patient was first seen in the OPD till the time of registration Diagnosis of GN was based on kidney biopsy for all patients included SPSS version 10 for windows was used for statistical analysis Results are given in mean ± standard deviation

Results Total number 117 patients  64 males  53 females Mean age8.6 ± 4.7 years Mean GFR28.6 ± Mean duration of follow up6.7±2.3 years

Results 72 (61.5%) patients were covered by the RMS Prevalence of CRF among Jordanian children in the year 2004  75 patients per million-child population

DiagnosisNumberPercent Congenital abnormalities Reflux nephropathy Neurogenic bladder NB without neurological deficit NB with spinal dysraphism Obstructive uropathy Renal dysplasia Hereditary conditions Oxalosis ARPKD Nephronephthesis Cystinosis Other Glomerulopathy Mesangio – capillary GN Henoch-Schonlein purpura Focal segmental glomerulosclerosis Crescentic GN Diffuse mesangial nephritis Post strept GN Hemolytic uremic syndrome Rhabdomyosarcoma Total

Conclusion Characteristics of CRF in Jordan is similar to that reported elsewhere with some peculiar features  High prevalence of reflux nephropathy as a cause of CRF Late referral Ante natal diagnosis  High incidence of neurogenic bladder as a cause of CRF especially that without neurological deficit  High incidence of oxalosis as a cause of ESRD It is important to establish a national registry to better verify the epidemiology of CRF in Jordanian children Regional registry ????

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