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Saudi Journal of Kidney Diseases and Transplantation
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Year : 1998  |  Volume : 9  |  Issue : 3  |  Page : 316-318
Acute Renal Failure in Sudan

Department of Medicine, Khartoum Dialysis and Transplantation Center, Khartoum, Sudan

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How to cite this article:
Sulieman SM. Acute Renal Failure in Sudan. Saudi J Kidney Dis Transpl 1998;9:316-8

How to cite this URL:
Sulieman SM. Acute Renal Failure in Sudan. Saudi J Kidney Dis Transpl [serial online] 1998 [cited 2022 Jan 18];9:316-8. Available from: https://www.sjkdt.org/text.asp?1998/9/3/316/39277

   Introduction Top

Acute renal failure (ARF) is a clinical condition, which presents with acute deterioration of renal functions, with or without oilguria.

Causes of ARF in different countries are usually determined by geographical, environ­mental, socioeconomic and cultural conditions. In countries where sophisticated medicine is sparse, ARF usually occurs secondary to trauma, snake bites, infections, abortions or self-poisoning [1],[2] . In countries with high technology medicine, most instances of ARF occur in the hospital as part of multiorgan dysfunction syndrome (MODS), most frequently as iatrogenic complications, and are associated with high mortality [3] .

In Sudan, a vast country in tropical Africa, where investigative facilities and dialysis centers are confined to district hospitals in the big cities [4] , the diagnosis of ARF is based on history of decreased urine output (so non-oliguric cases are usually missed) and detection of the commonly known causes. The exact incidence is not known but is expected to be high.

In Khartoum Teaching Hospital (where the author has been working for the last 25 years) the causes of ARF include a mixture of conditions seen in developing and developed countries. The pattern, however, is showing some changes over the years. Causes of ARF are usually described as pre-renal, post-renal and intrinsic renal. This classification will be used in this paper.

   Pre-renal Causes of ARF Top

These are very common in Sudan especially among children and result from loss of effective circulating blood volume. The commonest causes include diarrheal diseases, massive blood loss and primary cardiac failure.

Diarrheal Diseases:

Diarrheal diseases (e.g. gastroenteritis, bacillary and amebic dysentery and  Salmonellosis More Details) are common in the country especially among people of low socio­economic status. Also, outbreaks of cholera occur from time to time with very high mortality rate due to delay in institution of appropriate treatment.

Massive Blood Loss:

Massive blood loss, e.g. hematemesis due to schistosomal esophageal varices, is very common in the Gezira area (Central Sudan).

Primary Cardiac Causes:

Primary cardiac causes leading to severe hypotension are less common, although there is a marked increase in incidence of ischemic heart disease in recent years particularly in younger age-group individuals.

   Post-renal Causes of ARF Top

A. Renal and ureteric stones are very common in Sudan. Statistics of the Ministry of Health for the year 1994 showed a high incidence of renal and ureteric calculi in Western and Eastern Sudan. These are mountainous areas with low water supply, and the available water is usually hard water from wells. Most of the patients have bilateral stones and raised blood urea and creatinine are common at presentation.

B. Patients with obstructive uropathy due to prostatic enlargement often present at a late stage, usually only after retention of urine occurs.

C. Gonorrheal and other venereal infections are very common in males and are usually inadequately treated thereby causing urethral strictures.

D. Recurrent urinary tract infections (UTI) are very common in females probably related to circumcision (specially the tight Pharoeic type). The practice is slowly dying away in urban communities but the effects are seen among majority of aged females. Also, UTI during childhood is usually not properly investigated and treated, resulting in recurrent attacks and chronic pyelonephritis in adulthood; sometimes presenting with ARF.

   Intrinsic Renal Causes of ARF Top

Acute on Chronic Renal Failure:

Many patients who presented with what was initially considered ARF showed on detailed evaluation signs of chronic renal disease, the acute exacerbation being caused by sudden stress, such as bacterial and viral infections, dehydration or malaria. In such patients, despite having documented infection, it was noticed that fever was usually absent or unremarkable.

i. Obstetrical Causes of ARF

Contraceptive pills were available freely in Sudan till 1990. Since then these pills are supplied only in family planning centers. This restriction of availability has witnessed a marked increase in the number of cases of ARF related to septic abortions particularly in unmarried females. Abortion is induced by using local or systemic herbs and chemicals (including hair-dye), usually at 8­16 weeks of gestation. When these cases are complicated by ARF, which is quite common in this setting, the mortality rate is alarmingly high. Causes of ARF in late gestation, including toxemia of pregnancy, antepartum hemorrhage, post-partum hemorrhage and puerperal sepsis, are common due to scarce or absent antenatal care in most areas of Sudan. In addition, Caesarian sections performed by unskilled young doctors in rural hospitals have resulted in ARF in some cases due to ligation or severing of one or both ureters.

ii. Chloroquine Resistant Malaria

Plasmodium falciparum malaria is becoming one of the most important causes of ARF supposedly due to intravascular hemolysis. Any fever is considered, by the general public, to be malaria unless proved otherwise and self-medication for many days is common practice. Many such patients present with coma and/or convulsions, often with ARF. There has been a marked increase in the number of these cases in the last three years, with high mortality rate in patients in whom dialysis was not started early.

iii. Hair-dye Poisoning

Hair-dye (paraphenylene diamine) poisoning is a common cause of ARF in Sudan [5] . Early dialysis improves the outcome in most patients.

iv. Snake-bites

Snake-bites used to be very common in the late 70's and early 80's. The incidence decreased for a few years but increased again after the rams -and floods of 1988. The most common snake seen in Sudan is the Echis carinatus, one of the most poisonous snakes in the world. Most patients bitten by members of this species present with ARF, in addition to bleeding tendencies and peripheral gangrene. Dialysis, when available is life saving.

In conclusion, the causes of ARF in Sudan are similar to those that are seen in most developing countries. Most of the cases can be prevented by ensuring better health care facilities, good health education regarding use of drugs and chemicals and early consultation of qualified physicians in case of any illness.

   References Top

1.Chugh KS, Sakhuja V, Malhotra HS; Pereua BJ. Changing trends in acute renal failure in third world countries-Chandigarh study. Q J Med 1989;73:1117-23.  Back to cited text no. 1    
2.Seedat YK, Nathoo BC. Acute renal failure in blacks and Indians in South Afiica­comparison after 10 years. Nephron 1993;64:198-201.  Back to cited text no. 2  [PUBMED]  
3.Brivet FG, Klienknecht DJ, Loirat P. Landais PJ. Acute renal failure in intensive care units, causes, outcome, and prognostic factors of hospital mortality. A prospective multicentre study. Crit Care Med 1996;24;192-8.  Back to cited text no. 3    
4.Sulieman SM, Beliela MH, Hamza H. Dailysis and transplantation in Sudan. Country Report. Saudi J Kidney Dis Transplant 1995;6(3):312-4.  Back to cited text no. 4    
5.Sulieman SM, Fadlalla M s Nasr MM, etal. Poisoning with hair-dye containing paraphenylene diamine: ten years experience. Saudi J Kidney Dis Transplant 1995;6(3):286-9.  Back to cited text no. 5    

Correspondence Address:
Salma Mohamed Sulieman
Department of Medicine, Khartoum Dialysis and Transplantation Center, P.O. Box 102, Khartoum
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PMID: 18408307

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