Spectrum of Renal Bone Disease in Children with Renal Failure in Khartoum State

Renal osteodystrophy is the disorder of mineral metabolism that affects the skeleton in patients with chronic renal failure. It is one of the most important complications of chronic renal failure (CRF); it may result in considerable morbidity in children, it affects skeletal growth and development leading to bone deformities and often deceleration of linear growth. A cross sectional, prospective hospital based study was carried out during the period from Nov. 2003 to Feb. 2004 at Dr.Salma Dialysis & Transplantation centre, Dialysis unit of Soba University Hospital, Khartoum Teaching Hospital, and Ahmed Gasim Hospital and Bahri Renal Centre. The aims of the study were to determine the pattern and magnitude of renal osteodystrophy (ROD) and to study the clinical manifestations of ROD as well as to review the current approach to the diagnosis and management. The study consisted of 57 children with a mean age of 12.5 years (Range:1.5 – 18 yrs), male patients constituted 34 (59.6%). Fourteen patients (24.6%) were diagnosed as CRF and 43 (75.4%) were end stage renal failure (ESRD). The cause of renal failure was undetermined in the majority of patients 28 (49.1%) ix and most patients 34 (59.6%) were on haemodialysis. Renal osteodystrophy was documented in 36 (63.1%) patient. The mean height for age and weight for age Z-Scores distribution for patients with CRF was -2.1 standard deviation (SD) and the majority of children 22 (44.8%) had moderate growth impairment. The most common clinical findings of ROD were bone pain, joint pain and pruritis, they accounted for 58.8%, 52.9% and 52.9% respectively. Most patients with ROD had a high serum phosphorus (PO4) (63.8%), high serum parathyroid hormone (PTH) level (75%) and high alkaline phosphatase level (83.4%). The most common radiological findings was osteopenia, subperiosteal bone resorption and delayed bone age, they accounted for 88.8%, 72.2% and 69.4% respectively. The majority of children (77.2%) were not compliant with their diet. Although one alpha and calcium carbonate were given to almost all children (91.2% and 93% respectively). The dose was adjusted for only two children receiving one alpha and in only one child receiving calcium carbonate. The predominant pattern of ROD was secondary hyperparathyroidism (2ry HPTH) (52.6%), followed by normal bone (36.8%), mixed lesions and osteomalacia accounted for 5.2% each. At the end of the study 56.1% of children remained on dialysis, 15.8% died and only two children 3.5% were transplanted