الفهرس 
Chronic kidney diseaseOnly 14 pages are availabe for public view
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Abstract
End stage renal disease (ESRD) has become a worldwide health concern. In developed countries there is electronic data registry which allows easy statistical analysis and determination of the size of the problem for future planes. In developing countries there is no data registry and only scare data were available about epidemiology of dialysis patients.
The aim of this work is to study the clinical, laboratory and demographic data of the patients with ESRD at time of diagnosis and to demonstrate the trend of the prevalence of different etiological factors in Ain Shams University hospital between January 2005 and December 2009. All patients diagnosed as ESRD at Ain Shams University hospital between January 2005 and December 2009 were included in this study and their data were collected from the hospital renal unit registry including (age, sex, residence, special habits of medical importance, co-morbid conditions, family history, presumed cause of ESRD, pelvi-abdominal ultrasonographic findings, serum creatinine, blood urea nitrogen at onset of dialysis, Hbs Ag, HCV Ab, HIV Ab at onset of dialysis & the modality of renal replacement therapy used at onset of dialysis)
Data of 1600 patients were collected, their mean age was 52.5±15.3 years (range between 15 and 88 years), Males versus females were (48.7% Vs 51.3%). Patients from urban areas to rural areas were (70% Vs 30%). Positive family history of chronic kidney disease was detected in (11.9%). Smokers were (22%) and chronic analgesic abusers were (2.3%).
Renal replacement therapy modalities used on the study group were hemodialysis (93.2%) and peritoneal dialysis (5.4 %).
As regards the co-morbid conditions, hypertension was present in (54.7%), diabetes in (34.3%), chronic liver disease in (7.9%), cardiac disease in (5.4%), Systemic Lupus Erythematosus was found in (3.4%) and (24.8%) had no co-morbidities.
The main two causes of ESRD were hypertensive nephrosclerosis (27%) and diabetic nephropathy (24.6%), other causes were unknown etiology (16.6%), obstructive uropathy (9.9%), chronic glomerulonephritis (7.2%), chronic pyelonephritis (3.6%), lupus nephritis (3.4%), polycystic kidney disease (2.8%) and analgesic nephropathy in (1.9%). Certain etiologies were more common in females, as hypertensive nephrosclerosis (27.3%), diabetic nephropathy (30.7%) and lupus nephritis (5.6%) while other causes were more common in males, as obstructive uropathy (14.8%), chronic glomerulonephritis (8.3%) .
In the age groups < 19 years and 20-29 years, unknown etiology was the main cause of ESRD (51.3%) and (27.3%) respectively. In the age groups 30-39 years, 40-49 years and 70-79 years hypertensive nephrosclerosis was the main cause of ESRD (26.3%), (32.8%) and (38.2%) respectively. In the age groups 50-59 years, 60-69 years and more than 80 years diabetic nephropathy was the main cause of ESRD (34.1%), (33%) and (25%) respectively. On the other hand, unknown etiology was more common in the age groups < 19 years (51.3%), hypertensive nephrosclerosis was more common in the age group 70-79 years (38.2%), diabetic nephropathy was more common in the age group 50-59 years (34.1%), obstructive uropathy was more common in the age group <19 years (12.8%), chronic glomerulonephritis was more common in the age group 20-29 years (19.7%), chronic pyelonephritis was more common in the age group 20-29 years (6.1%), lupus nephritis was more common in the age group 20-29 years (20.5%), and finally, analgesic nephropathy was more common in the age group 50-59 years (3.2%).
The trend in the number of new patients starting dialysis treatment at Ain Shams University hospital between January 2005 and December 2009 was increasing from 257 patients in 2005 to 381 patients in 2009.
The trend in the mean age of ESRD patients in this study was increasing, from 51.7±15.6 years in 2005 to 53 ± 15.7 years in 2009.
The trend of the prevalence of etiology of ESRD of the studied group between January 2005 and December 2009 detected a decrease in the prevalence of hypertensive nephrosclerosis from (33.9%) in 2005 to (25.7%) in 2009 and chronic pyelonephritis from (4.7%) in 2005 to (3.1%) in 2009, while the prevalence of diabetic nephropathy increased from (21.8%) in 2005 to (26.5%) in 2009, unknown etiology increased from (10.1%) in 2005 to (19.9%) in 2009 and lupus nephritis increased from (2.7%) in 2005 to (3.4%) in 2009, with a highly significant statistical difference.
Clinical manifestations at presentation were mainly GIT symptoms in (48.6%), dyspnea and acidosis in (28.9%), volume overload in (13.7%), disturbed level of consciousness in (13.6%), oligurea to anurea in (8.7%), uncontrolled hypertension in (3.2%), easy fatigability in (2.9%) and (9.3%) were accidentally discovered.
Laboratory data of the studied group revealed that, positive HCV Ab was found in (25.8%) of patients, positive HBV Ag was found in (0.7%) of patients and positive HIV only in (0.1%) of patients, with a highly significant statistical difference (p value = 0.000) in the occurrence of HCV in males (57.5%) compared to females (42.5%) and a highly significant statistical difference (p value= 0.001) between urban and rural areas (64.3%) and (35.7%) respectively.
Mean BUN of the studied patients was (104.6 ± 40.3 mg/dl) and mean serum creatinine was (10.3±5.1 mg/dl).
Ultra-sonographic data of the studied group revealed the predominance of bilateral shrunken kidney (45.7%) followed by normal sized kidney (35.6%), stones ± hydronephrosis (10.1%), unilateral shrunken kidney (5.1%), enlarged kidney in (3.2%) and unilateral congenitally absent kidney in (0.3%).
Hypertensive nephrosclerosis was the main cause of ESRD in cases of bilateral shrunken kidney and unilateral shrunken kidney (46.5%) and (35.8%) respectively, diabetic nephropathy was the main cause of ESRD in patients with normal sized kidney (52.6%), obstructive uropathy was the main cause of ESRD in patients with stones ± hydronephrosis (74.7%) and polycystic kidney disease was the main cause of ESRD in cases of enlarged kidney (86.3%).