| Abstract|| |
Chronic renal failure (CRF) remains a significant cause of mortality in Yemen. There are about 568 patients with end-stage renal failure (ESRD) who receive chronic hemodialysis in seven centers in Yemen. We studied 372 CRF patients admitted for evaluation at our center from June 1997 to December 2000 in order to determine the pattern of etiology of their renal disease. Of the study patients, 253 (68%) were males and the age ranged from 4 to 80 years with a mean of 42.7 ± 38 years. There were 215 (57.8%) patients who had unknown causes of CRF, followed by post-renal causes such as urolithiasis and pyelonephritis. Hypertension and diabetes mellitus were the least encountered etiologies in our study patients. There were 243 (66.3%) patients who required dialysis because of symptoms and signs of advanced renal failure; 60.2% of them were hypertensive, 80.3% were anemic with a mean hemoglobin of 79.6 gm/l, 26.9% were hyperkalemic, 52.6% were hypocalcemic and 61.0% had hyperphosphatemia. We conclude that there are serious diagnostic and therapeutic problems in our health-care system that need addressing in order to improve health care.
Keywords: Chronic renal failure, dialysis, Yemen, Etiology.
|How to cite this article:|
Al-Rohani M. Causes of Chronic Renal Failure at one Center in Yemen. Saudi J Kidney Dis Transpl 2003;14:80-3
| Introduction|| |
Chronic renal failure (CRF) remains a significant cause of mortality in Yemen. There are many deficiencies of the diagnostic and therapeutic tools available in our hands. There is also severe shortage in the total bed capacity of our seven dialysis centers that are located in only major towns caring for 568 end-stage renal disease (ESRD) patients on maintenance hemodialysis. This number represents only about 15-25% of patients requiring dialysis.
We studied the data of the patients in our center in order to determine the pattern of etiology of their renal disease and the delivered care for the dialysis patients.
| Methods|| |
We studied 372 CRF patients admitted for evaluation in our center from June 1997 to December 2000. The evaluation included history of the disease, clinical examination and laboratory investigations that included radiological, biochemical, hematological, serological and electrocardiographic tests. Histopathology was not available during the study period.
| Results|| |
Of the study patients, 253 (68%) were males and 119 (32%) were females. The age of patients ranged from 4 years to 80 with a mean of 42.7 ± 38 years [Figure - 1]. The underlying etiologies of the renal disease in the study patients are summarized in [Table - 1]. The cause of renal failure was unknown in (57.8%), followed by the obstructive-renal diseases in 25.4% of the patients (55.3 % of these had urolithiasis) and pyelonephritis in 7.5%. Hypertension, diabetic nephropathy and polycystic kidney diseases were the etiology of the renal disease in only a small percentage of the study patients.
There were 243 (66.3%) patients who required dialysis because of symptoms and signs of advanced renal failure; 60.2% of them were hypertensive, 80.3% were anemic with a mean hemoglobin of 79.6 gm/l, 26.9% were hyperkalemic, 52.6% were hypocalcemic and 61.0% had hyperphosphatemia.
There were co-morbid conditions in 74% of the study patients; 65.8% cardiovascular followed by 14.5% viral diseases [Table - 2].
| Discussion|| |
Our hospital at Hajah is a referral hospital for a region that is the poorest in health service and hygienic level in Yemen with high prevalence of infectious diseases such as malaria and schistosomiasis. This fact is the reason why the prevalence of renal diseases is high in this area compared to other areas of Yemen such as Sanaa and Aden. However, we are not sure about the prevalence of the disease in the whole country since there are no studies available from the other areas. Most of the patients are characterized by illiteracy, low health education and low hygienic level.
The predialysis follow-up of the patients in our study was either deficient or non-existent. The diagnosis was speculative in the majority of patients since many of them presented in advanced stage of the disease
It was observed that the patients in our study were younger than those encountered in the USA with more preponderance of males.  Most of our patients, who required chronic dialysis presented to the emergency room in a very bad condition that mandated emergency dialysis.
In Yemen, malaria and streptococcal infection are highly prevalent. Most of our patients had a history of malaria and/or streptococcal infection. The high prevalence of these infectious diseases and the inappropriate treatment can lead to development of chronic infection and CRF.  The lack of the histopathological studies in our center hindered further delineation of the pathology and exact cause of the renal disease.
Obstructive-renal diseases, as a cause of CRF, were common in our study and more than half of them were related to urinary stone disease. Most of the patients with bilateral urolithiasis presented in advanced obstructive disease with deterioration of renal function.
Schistosomiasis is a known infectious cause of CRF. It usually results in calcifications and fibrosis of the urinary bladder and ureter besides the risk of urinary neoplasms.  It was responsible for 4.3% of all causes of renal failure in our study.
Chronic pyelonephritis as a cause of CRF was also noticeably present in our study. Bacterial infections were the main cause of pyelonephritis without significant difference between males and females.
Diabetic nephropathy was not common in our cohort, while it is a significant cause of CRF in the developed countries. ,, The prevalence of hypertension as a cause of ESRF is reported to range from 24.5 to 30% in the developed countries,  while it was judged to be the cause of CRF in only 2.6% of our study patients. Hypertension was, however, noted as a complication of advanced renal failure in more than 60% of our patients.
We conclude that there are serious diagnostic and therapeutic problems in our health-care system that need addressing in order to improve the care of our patients.
| References|| |
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|3.||Khurana P, Morad NA. Effect of Schistosomiasis on histopathologic pattern of urothelium in 262 bladder biopsies. Saudi Med J 1994;15(4):305-8. |
|4.||Rahman M, Smith MC. Chronic renal insufficiency: a diagnostic and thera-peutic approach. Arch Intern Med 1998;158 (14):1743-52. |
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Head, Department of Nephrology, Saudi Hospital at Hajah, P.O. Box 4365, Hudaidah
Source of Support: None, Conflict of Interest: None
[Figure - 1]
[Table - 1], [Table - 2]