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2016 ; 32
(5
): 1135-1140
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Functional and structural abnormalities of the kidney and urinary tract in
severely malnourished children - A hospital based study
#MMPMID27882009
Anjum M
; Moorani KN
; Sameen I
; Mustufa MA
; Kulsoom S
Pak J Med Sci
2016[Sep]; 32
(5
): 1135-1140
PMID27882009
show ga
OBJECTIVES: The association of malnutrition and systemic diseases like chronic
kidney disease (CKD) is well known. Various urinary tract abnormalities may be
associated with malnutrition. So objective of current study was to determine the
frequency of functional and structural urinary tract abnormalities in severely
malnourished children admitted in Nutritional Rehabilitation Unit (NRU) of a
tertiary care facility, Karachi. METHODS: This descriptive cases series of 78
children was conducted in NRU from October 2014 - March 2015. All newly admitted
children aged 2-60 months, diagnosed as Severe Acute Malnutrition (SAM) were
studied and children with known kidney and urinary tract disorders were excluded.
Detailed history, examination and investigations like serum creatinine,
ultrasound kidney and urinary tract in addition to routine tests for SAM, were
done. A proforma was used to collect demographic data, clinical history, physical
findings, and radio-imaging and biochemical investigations. Glomerular filtration
rate (GFR) was calculated using Schwartz equation. Data was analyzed using
descriptive statistics. RESULTS: Among 78 children, male to female ratio was
equal. Mean age was 18±15.53 months and majority (79.48%) of children were below
24 months. Majority (82%) of children with SAM had marasmus whereas 18% had
edematous malnutrition. Out of 78, 57 (73%) children had either functional
(80.7%) and or structural (19.3%) abnormalities whereas 21(36.84%) had normal
functional and structural status. Most common functional abnormality was
subnormal GFR (<90ml/min/1.73 m(2)) found in all 46 children. Functional
abnormities were more common in children below 24 months. Other functional
disorders were Bartter syndrome, renal tubular acidosis and urinary tract
infection (UTI) found in two cases each. Common structural abnormalities were
echogenic kidneys (n=4, 36%), hydronephrosis (n=3, 27%), hypoplastic kidneys
(n=3, 27%) and calculi (n=1, 9%). Subnormal GFR was also found in all cases with
structural abnormalities. UTI was observed exclusively in two children among 11
with structural abnormalities. CONCLUSION: A high frequency of functional
abnormalities and noticeable proportion of structural abnormalities of urinary
tract were detected in children with SAM. Current finding suggest that
multicenter study at national level may be undertaken to generate better data
about prevalence of renal diseases in SAM.