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A total of 127 patients with end-stage renal disease (ESRD) including 45 from Al-Madinah and 82 from the Gizan regions of Saudi Arabia were studied to determine the etiology of ESRD. The categorization into various diagnoses were according to established criteria. A total of 22 renal biopsies were also obtained to aid in the diagnosis. The mean age of the study patients was 50 years in Al-Madinah region and 37 years in Gizan region. Overall, the etiology could be established in 56 patients (44.1%) including 31 patients (68.9%) in Al-Madinah and 25 patients (30.5%) in Gizan regions. Diabetic nephropathy was the commonest cause of ESRD in Al-Madinah (45.2%) while obstructive nephropathy was the commonest identifiable cause in Gizan (24%). Our study suggests that diabetes and obstruction are the main conditions against which strategies for prevention and treatment should be directed.

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The Peutz-Jeghers syndrome (PJS) is known to be commonly associated with ovarian tumors. However, its association with testicular tumors is uncommon. We report an eight-year old boy who presented with gynecomastia and had Sertoli cell tumor of both testes with high aromatase activity. To the best of our knowledge, this is the seventh such case being reported in the literature and the presenting manifestation in all seven was gynecomastia.

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We report a case of a child with symptoms and signs of Bartter's syndrome and nephrocalcinosis. This report discusses the manifestations and management of this rare disease at a very early age.

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Pregnancy is an infrequent event in women at child bearing age who are on chronic dialysis therapy. To evaluate the incidence and the various therapeutic interventions on the outcome of pregnancy we studied 80 women on chronic hemodialysis. There were six pregnancies in five patients over six years of follow up (1988 -1994). To reduce the risk factors associated with pregnancy, we tried to control the blood pressure to a level below l50/90mmHg, to increase the duration and frequency of hemodialysis, to keep the hemoglobin level in the blood above 80 gm/L and to minimize the risk of bleeding by the usage of regional heparinization during the dialysis sessions. Also we kept predialysis BUN below 25mmol/L and used bicarbonate based dialysate. Two pregnancies ended with spontaneous abortion, three with premature delivery and only one had delivery on time. Two of the infants born alive died later during the neonatal period, while the other two are still alive - one, a girl, is now 5 years old and the other, a boy, is now 1 ½ years old. None of our pregnant women died. We conclude that pregnancy is of low incidence in hemodialysis patients, and is mostly unsuccessful. However, the modern advances in hemodialysis therapy, the wide choice of anti-hypertensive, the correction of anemia, and the improvement in the general health of HD patients may improve the outcome.

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Thirty seven patients with End Stage Renal Disease (ESRD) on maintenance hemodialysis at our center were studied for prevalence of Acquired Cystic Renal Disease (ACRD). Eighteen (49%) patients had documented ACRD. The mean age was 50.4 years. The proportion of patients with ACRD rose with increasing duration of dialysis. In our study, ACRD was found in 71.4% of patients who had dialysis for more than four years and in 43.3% of patients who underwent dialysis for less than four years. All of our patients with ACRD remained asymptomatic except one who had flank pain and macro-hematuria. There was no clinical or ultrasonographic evidence of renal neoplasm in any of these patients.

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This study was carried out to determine whether renal biopsy altered patient management or expected prognosis among children with renal disease. A retrospective analysis of case records of 106 children with renal disease having adequate renal biopsies was made. The diagnosis was altered in 47.2% and therapeutic approach was changed in 33% of the patients after obtaining the renal biopsy findings. Also, the estimate of prognosis was altered in 31.1% of the cases. These results were greater for patients with steroid resistant and congenital nephrotic syndrome, acute renal failure, asymptomatic urinary abnormalities and mixed nephritic-nephrotic syndrome. Subsequent management and prognosis was least affected by the biopsy results in patients with steroid sensitive nephrotic syndrome and chronic renal failure.

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