The mean age of the patients was 45.1(AE11.9) years (range of 22-80 years). There were 90 males and 60 females with male to female ratio of 1.5 : 1. The prevalence of CKD-MBD in the study population was 55.3%. Of this, 61 (73.5%) patients had low turnover bone disease while 22 (26.5%) patients had high turnover bone disease. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 36.7% and 13.3% of the study population, respectively but present in 34.9% and 12.0% of the CKD-MBD patients respectively. Other symptoms present in the study population included leg swelling in 126(84%), frothiness of urine in 123(82%), vomiting in 109(72.7%), facial puffiness in 102(68%), haematuria in 18(12%) and chest pain in 73(48.7%). The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and Ca x P product among the CKD-MBD patients were 205.06AE112.6 pg/ml, 2.56AE0.73mmol/l, 1.63AE0.63mmol/l, 109.26AE65.57IU/L and 4.07AE1.28mmol 2 /l 2 , respectively but the values among non CKD-MBD patients were 123.08AE120.99pg/ml, 2.32AE0.46mmol/l, 1.54AE0.57mmol/l, 108.13AE51.84I U/L and 3.52AE1.32mmol 2 /l 2 , respectively. There was hypercalcaemia in 44.6%, hypocalcaemia in 26.0%, hypophosphataemia in 12.0% and hyperphosphataemia in 29.3% of the patients. High alkaline phosphatase was observed in 36.0% while 8.7% had low alkaline phosphatase. There was high calcium x phosphate product in 34.0% of the patients. Hypercalcaemia was the most common biochemical abnormality in this study occuring in 44.6% of the patients while only 6% of those with CKD-MBD had radiological features of CKD-MBD. Conclusions: The prevalence of CKD-MBD in our environment is high and low turnover bone disease is the commonest type.
by the institutional hospital medical manager and ethical approval was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BE435/16). Results: The mean age of presentation was 6.2 years (SD AE3.4) with a mean follow-up of 3.0 years (SD AE2.4). One-hundred and twenty-one (52.4%) were males, 110(47.6%) females with a male to female ratio of 1.1:1. One hundred and sixty-six (71.9%) children were Black African and 65(28.1%) Indian. Indian patients presented at a younger age; between (1-3 years) compared to Black children (p<0.001). Seventy-six (32.9%) children were steroid sensitive (SS), 155(67.1%) steroid-resistant (SR). Black children are more likely to be SR [OR 2.0, p¼0.02, 95% CI (1.1-3.7)]. Kidney biopsy was performed in 209(90.5%) patients. Minimalchange disease (MCD) was seen in 32(13.9%) children, 162(70.1%) had focal segmental glomerulosclerosis (FSGS). Other histopathological forms of NS were seen in 15(6.5%) Black children only. Black patients were slightly more likely to have FSGS, this however did not reach statistical significance [122/166(73.5%) vs 40/65(61.5%), OR 1.73, p¼0.08, 95% CI (0.94-3.18)]. On comparing disease status at last hospital visit by race, 49/65(75.4%) Indian and 94/166(56.6%) Black children were in remission with Black children being less likely to be in remission compared to Indian children [OR¼0.47, p¼0.02, 95% CI (0.2-0.9)]. Fifteen of 65(23.1%) Indian and 47/166 (28.3%) Black children were in relapse with no significant difference between the two groups (p¼ 0.42). One (1.5%) Indian child compared to 25(15.1%) Black children had end-stage kidney disease (ESKD) [OR¼9.27, p¼0.03, 95% CI (1.2-70.4)], the majority of Black children with ESKD having FSGS. Only 16(61.5%) children received renal replacement therapy. Conclusions: Our study shows a rising incidence of FSGS (70.1%) with the majority having SRNS. Also, a higher percentage of Black children with both MCD and FSGS on histopathology were SS, in keeping with reports from other regions in South Africa.
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