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Long term outcome of treatment of end stage renal failure
P Henning1, L Tomlinson, S P Rigden
1Department of Nephrology, Adelaide Children's Hospital, South Australia.
Insights
Pediatric end-stage renal failure survivors achieved normal growth but faced challenges with final height and social integration. Many survivors experienced poor body image, impacting self-esteem and relationships.
Area of Science:
- Pediatric Nephrology
- Quality of Life Studies
- Longitudinal Health Outcomes
Background:
- End-stage renal failure (ESRF) in children presents significant long-term health and psychosocial challenges.
- Common causes of pediatric ESRF include reflux nephropathy, cystinosis, focal segmental glomerulosclerosis, and Schönlein-Henoch disease.
Purpose of the Study:
- To assess the long-term quality of life, renal function, and physical development of children surviving end-stage renal failure.
- To compare outcomes with a cohort of patients with juvenile onset diabetes.
Main Methods:
- Retrospective review of hospital records for 46 children treated for ESRF between 1972-1977.
- Follow-up assessment in 1985 using hospital records and a questionnaire on social and psychological issues.
- Comparison with a cohort of 32 juvenile diabetes patients.
Main Results:
- 31 survivors (mean age 22) showed normal growth during treatment, but many were dissatisfied with final height.
- Most survivors could walk and run, with 67% employed and 9 living independently.
- ESRF patients reported concerns about physical appearance and lacked stable sexual relationships compared to diabetics.
Conclusions:
- While physical function and employment rates are encouraging, pediatric ESRF survivors face significant psychosocial challenges, particularly regarding body image and relationships.
- Low self-esteem stemming from poor body image may contribute to social and relationship difficulties.
- Further research is warranted to address these psychosocial deficits in pediatric ESRF survivors.
Abstract:
The most common causes of end stage renal failure in 46 children (mean age 11 years, range 4-14) treated between January 1972 and June 1977 were: reflux nephropathy (n = 12), cystinosis (n = 7), focal and segmental glomerulosclerosis (n = 6), and Schönlein-Henoch disease (n = 5). The quality of life, degree of renal function, and height attainment of the 31 survivors were assessed in June 1985, when their mean age was 22 years (range 14-27), using hospital records and a questionnaire designed to highlight social and psychological problems. Twenty six patients had a functioning transplanted kidney. Average growth during treatment for all survivors was normal, but most were disappointed with their 'final height'. Though five patients had some form of disabling bone disease, all 31 could walk and 27 could run. Sixteen (67%) were in full or part time employment and nine were living independently. A group of 32 patients with juvenile onset diabetes treated at this hospital for at least five years were also asked to complete the questionnaire and of these, 17 responded. On average, their data could usefully be compared with those of cases of end stage renal failure. More of the diabetics had jobs, but most sexually mature patients with renal disease were concerned about their physical appearance and had not achieved any stable long term sexual relationships. We suggest that a poor body image resulting in low self esteem may be responsible for the deficiency and believe that further study in this group is warranted.