| Objective The clinical data of children with end-stage renal disease(ESRD),admitted to our hospital in the past 12 years,were retrospectively analyzed to investigate the etiological composition,clinical characteristics,complications,treatment,and outcome of ESRD in children and adolescents and provide a reference for its prevention,diagnosis and treatment.Methods 54 children with ESRD admitted to the Department of Pediatrics and Nephrology of the General Hospital of Ningxia Medical University from January 2010 to December 2021 were selected as the study subjects.Collect clinical general data,causes of first diagnosis,family history,laboratory tests,primary diseases,complications,renal biopsy pathology,genetic examination,treatment,and outcome,screen qualified clinical cases in strict accordance with the inclusion and exclusion criteria,and investigate the etiological distribution,complications and treatment of ESRD,Chi-square test,corrected Chi-square test or Fisher’s exact probability method were used for inter-group comparison,P ≤ 0.05 was statistically significant.Results1.Among the 54 children with ESRD,32 were male and 22 were female,with a male-to-female ratio of 1.45:1;4(7.41%)was aged 0 to 6 years,14(25.93%)were aged 7 to11 years,and 36(66.67%)were aged 12 to 18 years.The age of initial visit ranged from 6months to 18 years old,with an average of(10.9 ± 4.9)years.The age of diagnosis ranged from 2 to 18 years,and the mean age was(13±3.8)years.The median duration of disease before diagnosis was 0.17(0.02,1.7)years.46 from Ningxia,8 from peripheral provinces,30 from rural areas,24 from urban areas,towns: rural = 0.8:1.Nine children with ESRD were admitted from 2010 to 2015,and 45 children with ESRD were admitted from 2016 to 2021.2.Among the etiological constitution,24 cases(44.44%)of glomerular diseases ranked first,mainly chronic glomerulonephritis;the others were congenital renal and urethral malformations in 11 cases(20.37%),hereditary kidney disease in 5 cases(9.26%),other etiologies in 5 cases(9.26%),and unknown etiologies in 9 cases(16.67%).3.Fifteen of the 54 children presented first with the onset of renal-related symptoms,among which edema and oliguria(9 cases)were the most common;In 39 cases,extrarenal symptoms were the reason for the first visit,with gastrointestinal symptoms being the most common,followed by respiratory symptoms,and a few children were found due to other diseases or physical examinations.4.The most common complication of ESRD was anemia,which was accompanied by varying degrees of anemia in 54 children,with an incidence of 100%,with moderate anemia being the most common.There was no difference in the occurrence of anemia between genders,age groups,and etiologies(p>0.05).This was followed by hyperphosphatemia(98.15%),hyperuricemia(83.33%),secondary hyperparathyroidism(79.63%),hypocalcemia(74.07%),hypertension(61.11%),25(OH)vitamin D deficiency(53.7%),growth failure(33.33%)and hyperkalemia(29.6%).5.Seven of the 5.54 children underwent renal biopsy,with a biopsy rate of 29.17%,including 4 cases of primary glomerular disease(2 FSGS,1 FSGS with Ig M,and 1 Ig A nephropathy)and 3 cases of secondary glomerular disease(2 Henoch-Schonlein purpura nephritis type IVb and 1 lupus nephritis type V + IIIa/c).6.After the initial diagnosis,41 children(75.90%)underwent initial renal replacement therapy,of which 28(63.00%)preferred hemodialysis,10(18.50%)preferred peritoneal dialysis,and 3 chose peritoneal dialysis combined with hemodialysis;7(13.00%)chose conservative treatment;and 6(11.11%)abandoned treatment.Thirteen children(24.07%)underwent renal transplantation within 0.5 to 6 years of dialysis treatment,one of whom died3 years after two transplants.7.Among 54 ESRD children,32 cases(59.26%)were followed up continuously,including 12 cases of hemodialysis,8 cases of peritoneal dialysis,and 12 cases of kidney transplantation,8 cases(14.81%)were lost to follow-up,14 cases(25.93%)died,6 cases died after giving up treatment,6 cases died of "infection",4 cases died of "cardiovascular disease",2 cases died of "respiratory failure",and 2 cases died of an unknown cause.Conclusion1.End-stage renal disease in children and adolescents can occur at any age,but it has the highest incidence in adolescent children,is higher in boys than in girls,and is higher in rural areas than in urban areas.Children with ESRD admitted in the past 6 years were significantly higher than those in the first 6 years.2.Glomerular disease was the main cause of ESRD in 54 children,and chronic glomerulonephritis accounted for a large proportion,followed by congenital renal and urinary tract malformations(CAKUT).3.The first symptoms of ESRD in children are diverse and non-specific,and the onset of extrarenal symptoms is more common.4.54 ESRD children had varying degrees of anemia,mainly moderate anemia,the next most common complications were CKD-MBD,hyperuricemia,hypertension,and growth failure.5.Renal replacement therapy in children with ESRD is based on hemodialysis,and the number of renal transplants has increased in recent years.6.The common causes of death in children with ESRD are infection and cardiovascular disease,of which infection ranks first. |
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