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Functional and structural abnormalities of the kidney and urinary tract in severely malnourished children - A
Misbah Anjum1, Khemchand N Moorani2, Ifra Sameen3
1Misbah Anjum, MBBS, FCPS. Assistant Professor, Department of Pediatric Medicine (Unit-III), National Institute of Child Health (NICH), Jinnah Sindh Medical University (JSMU), Karachi, Pakistan.
Insights
Severely malnourished children often have urinary tract abnormalities, including functional issues like low GFR and structural problems. Early detection is crucial for managing these renal complications in severe acute malnutrition (SAM).
Area of Science:
- Pediatric Nephrology
- Nutritional Sciences
- Public Health
Background:
- The link between malnutrition and systemic diseases, including chronic kidney disease (CKD), is established.
- Urinary tract abnormalities are frequently associated with malnutrition in children.
Purpose of the Study:
- To determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children.
- To investigate renal function and urinary tract structure in children admitted to a Nutritional Rehabilitation Unit (NRU).
Main Methods:
- A descriptive case series of 78 children aged 2-60 months with Severe Acute Malnutrition (SAM) was conducted.
- Exclusion criteria included pre-existing kidney or urinary tract disorders.
- Investigations included history, physical examination, serum creatinine, ultrasound of the kidney and urinary tract, and GFR calculation using the Schwartz equation.
Main Results:
- 73% of children exhibited functional and/or structural urinary tract abnormalities.
- The most common functional abnormality was subnormal Glomerular Filtration Rate (GFR) (<90ml/min/1.73 m2), present in all 46 affected children.
- Common structural abnormalities included echogenic kidneys, hydronephrosis, and hypoplastic kidneys. Urinary tract infections (UTIs) were observed in two cases.
Conclusions:
- A high prevalence of functional and a significant proportion of structural urinary tract abnormalities were found in children with SAM.
- These findings highlight the need for comprehensive renal assessment in severely malnourished children.
- A national, multicenter study is recommended to better understand the prevalence of renal diseases in SAM.
Objectives:
The association of malnutrition and systemic diseases like chronic kidney disease (CKD) is well known. Various urinary tract abnormalities may be associated with malnutrition. So objective of current study was to determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children admitted in Nutritional Rehabilitation Unit (NRU) of a tertiary care facility, Karachi.
Methods:
This descriptive cases series of 78 children was conducted in NRU from October 2014 - March 2015. All newly admitted children aged 2-60 months, diagnosed as Severe Acute Malnutrition (SAM) were studied and children with known kidney and urinary tract disorders were excluded. Detailed history, examination and investigations like serum creatinine, ultrasound kidney and urinary tract in addition to routine tests for SAM, were done. A proforma was used to collect demographic data, clinical history, physical findings, and radio-imaging and biochemical investigations. Glomerular filtration rate (GFR) was calculated using Schwartz equation. Data was analyzed using descriptive statistics.
Results:
Among 78 children, male to female ratio was equal. Mean age was 18±15.53 months and majority (79.48%) of children were below 24 months. Majority (82%) of children with SAM had marasmus whereas 18% had edematous malnutrition. Out of 78, 57 (73%) children had either functional (80.7%) and or structural (19.3%) abnormalities whereas 21(36.84%) had normal functional and structural status. Most common functional abnormality was subnormal GFR (<90ml/min/1.73 m2) found in all 46 children. Functional abnormities were more common in children below 24 months. Other functional disorders were Bartter syndrome, renal tubular acidosis and urinary tract infection (UTI) found in two cases each. Common structural abnormalities were echogenic kidneys (n=4, 36%), hydronephrosis (n=3, 27%), hypoplastic kidneys (n=3, 27%) and calculi (n=1, 9%). Subnormal GFR was also found in all cases with structural abnormalities. UTI was observed exclusively in two children among 11 with structural abnormalities.
Conclusion:
A high frequency of functional abnormalities and noticeable proportion of structural abnormalities of urinary tract were detected in children with SAM. Current finding suggest that multicenter study at national level may be undertaken to generate better data about prevalence of renal diseases in SAM.
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