PATTERN AND OUTCOME OF RENAL DISEASES IN HOSPITALIZED CHILDREN IN TIKUR ANBESSA SPECIALIZED TEACHING HOSPITAL, ADDIS ABABA, ETHIOPIA
Background: Renal diseases are major causes of morbidity and mortality in pediatric practice. Pediatric patients with renal disease, especially younger ones may present with nonspecific signs and symptoms unrelated to the urinary tract. Unexplained fever or failure to thrive may be the only manifestation. Most children with renal diseases in our hospital arrive very late either because of inadequate health awareness among the parents or failure of recognizing the symptoms of renal diseases at a lower health care level. This review will highlight the symptoms of renal diseases at presentation and outcomes of treatment in children in a major referral hospital.
Methods: A cross-sectional retrospective chart review was done over a period of 3 years (June, 2012 to May, 2015) in 381 admitted children (Birth-17 years) at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia.
Results: Out of 14521 pediatric ward admissions in the study period, kidney diseases accounted for 473 admissions in 381 children, accounting for 3.3% of all admissions. The three most common renal diseases observed were congenital anomalies of the kidney and urinary tract (CAKUT) seen in 127 children (26.8%), followed by nephrotic syndrome in 80 children 16.9% and acute glomerulonephritis in 58 children (12.2%). Other renal diseases observed were urinary tract infection 8.0%, urolithiasis 6.7%, Wilm’s tumor 6.3%, acute kidney injury 4.2% and chronic kidney disease 4.0%. Other less frequently detected diseases were bladder exstrophy, lupus nephritis, Henock shonlein Purpura nephritis and prune-belly syndrome.
Out of 381 children 207 (54.3%) recovered normal renal function, 20(5.2%) remained with proteinuria, 13(3.4%) progressed to chronic kidney disease and 11(2.9%) died. Sixty one nephrotic children (76.3%) achieved remission but 17 children (21.3%) remained with proteinuria; one steroid resistant child died of end stage renal disease. Ten children (2.6%) with different renal diseases were lost to follow-up and 5 (1.3%) discharged against medical advice.
Conclusions: This data reflects that many of the renal diseases are preventable or potentially curable. Therefore, improvement of pediatric renal services and training of health workers would help in early detection and treatment of these conditions leading to reduction in their morbidity and mortality.
Key Words: Renal disease, Children, Ethiopia
Barakat A. Presentation of the Child with Renal Disease and Guidelines for Referral to the Pediatric Nephrologist. Internat J Pediatr 2012,1-5.
Bunchman T. Pediatric chronic kidney disease: Lack of overt symptoms makes diagnosis challenging. Nephrology times 2008; 1(4): 23-28.
Bhatta NK, Shrestha P, Budathoki S, et al. Profile of renal diseases in Nepalese children. Kathmandu University Medical Journal 2008; 6 (2): 191-194.
Javed I, Maaz A. Rehman, Mushtaq A. Pattern of Renal Disease in Children. J Pak Med Assoc 2000; 50: 118-20.
Ali EM, A/Rahman AH, Karrar ZA. Pattern and outcome of renal diseases in hospitalized children in Khartoum State, Sudan. Sudan J Paediatr 2012; 12(2):52-59.
Ladapo TA, Esezobor CI, Lesi FE. Pediatric Kidney Diseases in an African Country: Prevalence, Spectrum and Outcome. Saudi J Kidney Dis Transpl 2014; 25(5):1110-16.
Nelson OS, Michelle L, Juan CM, Juan BC. Renal diseases in Children, Venezuela. Ped. Nephrol 2002;17: 566-69.
Ali SH, Hussien FS, Abd Al-Amer H. Profile of Renal Diseases in Iraqi Children: A Single-Center Report. Saudi J Kidney Dis Transpl 2015; 26(3):613-18.
Elzouki AY, Amin F, Jaiswal P. Prevalence and pattern of renal disease in eastern Libya. Archives of Disease in Childhood 1983; 58: 106-09.
Ugwu G, Nwajei G, Chinemelu U. Pattern of Renal Diseases among Children in the Niger Delta Region, Nigeria. Arab J Nephrol Transplant 2014 January; 7(1): 49-50.
Cruz FS, Carbera W, Barreto S, Mayor MM, Ba´ez D. Kidney disease in Paraguay. Kidney International 2005; 68:120–25.
Damte Shimelis, editor. Handbook on the management of pediatric renal problems in Ethiopia. 1st ed. Addis Ababa: June 2011;55-87.
Gheissari A, Mehrasa P, Merrikhi A, Madihi Y. Acute kidney injury: A pediatric experience over 10 years at a tertiary care center. J Nephropathology 2012; 1(2): 101-08.
Bazina M, Galvaina-Durdov M. Epidemiology of renal disease in children in the region of Southern Croatia. Med Sci Monit 2007; 13:172-6.
Isaac E, Ocheke, Selina N, Okolo, Fidelia Bode-Thomas, Emmanuel I. Agaba. Pattern of Childhood Renal Diseases in Jos, Nigeria: A preliminary Report. Journal of Medicine in the Tropics 2010; 12:52-55.
Zhong Y, Shen Y, Feld LG. Changing pattern of glomerular diseases at Beijing children hospital. Clin Pediatr 1994; 33(9):542-47.
Barrat TM, Greifer I. Paediatric nephrology around the world. In: Barrat TM, Anver ED, Harman WE, eds. Paediatric Nephrology, 4th ed. Pennsylvania: Awolters Co 1999; 1364-65.
Orta-Siba N, Lopes M, Moriyan JC. Renal diseases in children in Venzuela. Pediatr Nephrol 2002; 17(7): 566-69.
Eke FU, Eke NN. Renal disorders in childhood: a Nigerian study. Paediatr Nephrol 1994; 8 (3): 383-86.
Derakhshan A, Al Hashem GH, Fallhzadeh MH. Spectrum of In-patient Renal Diseases in Children; A Report from Southern part Islamic Republic of Iran. Saudi J Kidney Dis Transpl 2004; 15(1):12-17.