The clinical pattern and outcome of renal failure in Sudanese children in Khartoum State .


Research type: Research Paper

Authors: Mohamed, Amani Abdel Rahman .

Abstract: Renal failure is a serious illness affecting the lives of children and their families adversely. a prospective hospital based study was carried out in the period from May 1997 to June 1998. The aims of this study were to determine the clinical pattern of presentation of renal failure. Out come and cases. As well as to assess the growth of hte affected childre, their school performance and the family attitude towards the illness. It was conducted in patients admitted to Khartoum Children Emergency Hospital, Omdurman Children Emergency Hospital, Khartoum North Hospital, Soba University Hospital, and Ibn Sina Hospital. The study consisted of 87 children with renal failure aged one day up to sixteen years. Moreover there was a control group matched for age, sex and social class for comparative growth assessment (n equal 87). Renal failure occurred more commomly in males( 58.6 percent) than females. Most of the patients with renal failure (47.1 percent) were in the age group 10-16 years. The majority of the patients (71.3 percent) were from the Arab tribes. Oliguria was the commonest urinary symptom at presentation, found in (69 percent) of the patients. Gastrointestinal symptoms in form of nausea, anorexia and vomiting were almost universal occurring in (90.8 percent) of the patients. Pallor was the cardinal sign on examination dtected in (82.8 percent) of the patients. Puffy face and lower limb oedema occurred commonly, while ascitis was detected with lesser frequency (36.8 percent). No patient had signs of renal osteodystrophy. Acute renal failure occurred in (23 percenr while chronic renal failure in (77 percent) of the patients. The commonest causes of acute renal failure weere acute tubular necrosis (35 percent), acute glomerulonephritis in (25 percent), posterior urethral valve in (15 percent, haemolytic uraemic syndrome in (10 percent). (10 percent) of the patients had acute renal failure following severe dehydration, while in (5 percent) it occured as a consequence of abdominal surgery. Chronic glomerulonephritis was the commonest cause of chronic renal failure, found in (52.2 percent), followed by urinary calculi in (7.5 percent), chronic pyelonephritis (4.5 percent), polycystic disease of the kidney in (4.5 percent). Alport's syndrome in (3 percent) whereas nephrocalcinosis and Wilms' tumor occurred in (1.5 percent) of patients respectively. The cause of chronic renal failure was unidentified in (25.3 percent) of the patients. (26.5 percent) of patients were treated conservatively, (27.2 percent) were dialysed, I patient had renal transplant abroad. In this study (57.5 percent) of the patients improved, (27.6 percent) died, and (14.9 percent) were lost for follow up. Out of the 58 patients who were in the basic level education. (82.8 percent) left the school, (8.6 percent) were irregular attendants and another (8.6 percent) of patients were attending their schools regularly. Only (10.40) of the patients were of excellent standards at school. Only (10.3 percent) of the parents could afford to do the investigations in the successive admissions. All parents were apprehensive towards the illness of their children and as well all of them were concerned about their children's death. (31 percent) of the parents were inconvenient about the management because of the high cost (55.6 percent), lack of transplantation (29.6 percent) non explanation of the problem (11.1 percent) and the lack of expression of sympathy of the treating staff in (3.7 percent). There was significant reduction in growth parameters of patients with chronic renal failure, those with acute renal failure were less affected. Renal failure is a serious illness that affected the children. Malaria was a common precipitating cause of acute renal failure, that needs prevention and proper treatment. Heridofamilial causes of renal failure were not common. The burden on the family to care for the child was enormous. This necessitates a national multidisciplinary approach to improve the outcome.