Poudel D R, Basnet S, Shrestha L P
Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
Kathmandu Univ Med J (KUMJ). 2022 Apr-Jun;20(78):198-202.
Background Chronic kidney disease in children has been increasing over the years and is associated with high degree of morbidity and mortality. The cost of treating children with chronic kidney disease is also substantial. Prevention of this disease is the only long term solution in our context. Till date, there is limited data on chronic kidney disease in Nepalese children. Objective To study the epidemiological, clinical and etiological profile of children with Chronic Kidney Disease from 2 to 16 years of age presenting for the first time in tertiary care hospital. Method This is the prospective observational study carried out at the tertiary care hospital over a period of 3 years. Children between 2-16 years who were first time diagnosed of chronic kidney disease and had estimated glomerular filtration rate < 60 ml/ min/1.73 m2 for last 3 months were enrolled. Result There were total of 124 patients, of whom 78 were male with male to female ratio of 5:3 with mean age of 11.8±2.2 years. Chronic glomerulonephritis (23%), reflux nephropathy (23%) and nephrolithiasis (16%) were the commonest etiological diagnosis. Rapidly progressive glomerulonephritis and systemic lupus erythematous accounted for 85% cases of chronic glomerulonephritis. Vesicoureteric reflux and posterior urethral valve accounted for 85% cases of reflux nephropathy. In 32%, the cause could not be determined. Swelling (45%) and dyspnea (20%) were the chief presenting complaints. Pallor were seen in all cases (100%) followed by hypertension in 68% and short stature in 64%. Majority (60%) of the patients with chronic kidney disease presented in the stage V. Conclusion Chronic glomerulonephritis and reflux nephropathy were the commonest etiologies of chronic kidney disease, majority of them following rapidly progressive glomerulonephritis, systemic lupus erythematosis, vesicoureteric reflux and posterior urethral valve. The commonest clinical features were swelling, dyspnea, pallor and hypertension.
多年来，儿童慢性肾脏病的发病率一直在上升，且与高发病率和死亡率相关。治疗儿童慢性肾脏病的费用也相当高昂。在我们的情况下，预防这种疾病是唯一的长期解决方案。迄今为止，关于尼泊尔儿童慢性肾脏病的数据有限。目的：研究首次在三级护理医院就诊的2至16岁慢性肾脏病儿童的流行病学、临床和病因学特征。方法：这是一项在三级护理医院进行的为期3年的前瞻性观察研究。纳入2至16岁首次被诊断为慢性肾脏病且过去3个月估计肾小球滤过率<60 ml/ min/1.73 m2的儿童。结果：共有124例患者，其中男性78例，男女比例为5:3，平均年龄为11.8±2.2岁。慢性肾小球肾炎（23%）、反流性肾病（23%）和肾结石（16%）是最常见的病因诊断。急进性肾小球肾炎和系统性红斑狼疮占慢性肾小球肾炎病例的85%。膀胱输尿管反流和后尿道瓣膜占反流性肾病病例的85%。32%的病例病因无法确定。肿胀（45%）和呼吸困难（20%）是主要的就诊主诉。所有病例均有面色苍白（100%），其次是高血压（68%）和身材矮小（64%）。大多数（60%）慢性肾脏病患者处于V期。结论：慢性肾小球肾炎和反流性肾病是慢性肾脏病最常见的病因，其中大多数继发于急进性肾小球肾炎、系统性红斑狼疮、膀胱输尿管反流和后尿道瓣膜。最常见的临床特征是肿胀、呼吸困难、面色苍白和高血压。
