Miller M E Y, Williams J A
Department of Child Health, The University of the West Indies, Kingston 7, Jamaica, West Indies.
West Indian Med J. 2009 Jun;58(3):231-4.
This study evaluated the incidence, epidemiology, aetiology and outcome of chronic renal failure (CRF) in Jamaican children < 12 years old between 2001 and 2006.
The required data on all children who fulfilled inclusion criteria were obtained from their medical records at the University Hospital of the West Indies, Bustamante Hospital for Children and from practitioners in hospitals serving children islandwide.
Eighteen new children (72.2% male) presented with CRF. The cumulative annual incidence was 4.61/million child population under age 12 years or 1.14/million total population. Congenital urological disease (44.5%) was the commonest cause of CRF, followed by glomerulonephritis (33.3%). Half of the cases of glomerulonephritis were secondary to HIV-associated nephropathy. Although all children with posterior urethral valves were diagnosed before age 6 months and promptly treated, renal failure present at birth proved irreversible. The mean age at diagnosis of CRF was 6.72 years. Ten children (55.6%) were already in CRF at first presentation with renal disease. Of these, the five with non-urological disease were already in End Stage Renal Disease (ESRD). Mortality was 44.4%. Five children died in ESRD without the benefit of dialysis.
The incidence of CRF has increased from the 1985-2000 local study and is mainly due to urological pathology which progresses despite early diagnosis and treatment. Non-urological renal disease is presenting too late for therapeutic intervention. Greater public awareness of symptoms of renal disease is needed. Children's access to dialysis is unpredictable. A paediatric dialysis and transplantation programme is needed.
本研究评估了2001年至2006年间牙买加12岁以下儿童慢性肾衰竭（CRF）的发病率、流行病学、病因及转归。
符合纳入标准的所有儿童的所需数据，来自西印度大学医院、 Bustamante儿童医院的病历，以及全岛为儿童服务的医院的从业者。
18名新发病儿童（男性占72.2%）出现慢性肾衰竭。12岁以下儿童的累积年发病率为4.61/百万儿童人口，或占总人口的1.14/百万。先天性泌尿系统疾病（44.5%）是慢性肾衰竭最常见的病因，其次是肾小球肾炎（33.3%）。一半的肾小球肾炎病例继发于HIV相关性肾病。尽管所有后尿道瓣膜患儿在6个月前被诊断并得到及时治疗，但出生时即存在的肾衰竭被证明是不可逆的。慢性肾衰竭的平均诊断年龄为6.72岁。10名儿童（55.6%）首次出现肾病时已处于慢性肾衰竭阶段。其中，5名非泌尿系统疾病患儿已处于终末期肾病（ESRD）。死亡率为44.4%。5名儿童在未接受透析的情况下死于ESRD。
与1985 - 2000年的当地研究相比，慢性肾衰竭的发病率有所上升，主要原因是泌尿系统病理改变，尽管早期诊断和治疗仍会进展。非泌尿系统肾病出现时已太晚，无法进行治疗干预。需要提高公众对肾病症状的认识。儿童获得透析的机会难以预测。需要一个儿科透析和移植项目。
