Chronic renal failure in Sudanese children: aetiology and outcomes

Area of Science:

• Pediatric Nephrology
• Chronic Renal Failure (CRF) Research
• Renal Replacement Therapy Outcomes

Background:

• Increasing referrals of children with chronic renal failure (CRF) to tertiary pediatric nephrology units.
• The study period (2001-2006) saw improvements in socioeconomic conditions, facilitating increased provision of dialysis and transplantation.
• Geographical variations in CRF etiology are influenced by referral patterns, environmental, and societal factors.

Purpose of the Study:

• To report the etiology and outcomes of pediatric chronic renal failure (CRF) over a 5-year period.
• To analyze the impact of improving socioeconomic conditions on the provision of renal replacement therapy.
• To identify areas for future investigation and potential improvements in managing pediatric CRF.

Main Methods:

• Retrospective review of medical records for 205 children diagnosed with CRF (glomerular filtration rate < 50 ml/min/1.73 m²).
• Data collected between 2001 and 2006 from a tertiary pediatric nephrology unit in Khartoum.
• Analysis of etiological factors, treatment modalities (dialysis, transplantation, conservative), and patient outcomes.

Main Results:

• The most common etiologies for CRF were chronic glomerulonephritis (25.4%) and congenital urological malformations (17.5%), with 39.1% having unknown causes.
• Of 205 children, 136 reached end-stage renal failure, with various dialysis modalities used; 25.9% remained on dialysis at study end.
• High mortality (23.4%) and loss to follow-up (22%) were observed; only 3.9% received transplants.

Conclusions:

• The study highlights significant geographical variations in CRF etiology and the need for prospective investigation into unknown causes.
• Improving socioeconomic factors positively impacted treatment availability but did not fully mitigate high mortality rates.
• Earlier referral, improved nutrition, family support, and enhanced access to kidney transplantation are crucial for improving outcomes in pediatric CRF.