Over a 7-year period (1990-1997) spontaneous gastric perforation was diagnosed in five neonates. The mean gestational age and birth weight were 33/40 weeks and 1.83 kg, respectively. All patients presented with severe abdominal distention and frank pneumoperitoneum on roentgenograms. All perforations were on the anterior wall of the greater curvature and were managed by prompt laparotomy and primary closure of the perforation. No gastrostomy was used, however, peritoneal drainage was used in all cases. There was no mortality or morbidity. An attempt to understand the possible etiology together with a review of the literature is presented.

The study includes 17 infants with nephrotic syndrome. Their ages at the onset of disease ranged from 10 days to 10 months (median 2 months), and included 10 males and 7 females. Ten patients had consanguineous parents and 4 had a history of similar illness in the sibling. Renal biopsy revealed diffuse mesangial proliferation in 10 patients, diffuse mesangial sclerosis in 3, Finnish microcystic disease in 2, and focal segmental glomerulosclerosis and atypical glomerulopathy in 1 each. Unilateral nephrectomy was performed in 8 patients with intractable proteinuria associated with multiple complications. Five are well after 4-36 months follow-up, 1 died of septicaemia soon after the procedure, 1 needed dialysis and is stable at 26 months and 1 showed no reduction in the degree of proteinuria. We conclude that unilateral nephrectomy is a better alternative to bilateral nephrectomy in some infants with severe nephrotic syndrome.

Hyperostosis is a common side effect of prolonged prostaglandin therapy. Abnormal facial features, hypertrichosis and coarse skin are additional adverse effects of long term therapy. Serum alkaline phosphatase activity can be used as a marker of the hyperostosis. In addition to other bones clavicles can also be involved. The above effects seem to be both dose and duration dependent.

This study includes 100 children (male to female ratio, 65:35) with chronic renal failure referred to our renal unit from different parts of the Kingdom over a period of three years. Their ages ranged from 1 to 13 years with a median age of 4 years. Malformations of the urinary tract were the most common cause of chronic renal failure (N = 34) followed by heredofamilial disorders (N = 18), renal hypoplasia/dysplasia (N = 17), glomerulopathies (N = 14), and miscellaneous diseases (N = 5). No diagnosis could be made in 12 patients because of late referral. Of the 40 patients treated for terminal renal failure, 22 are on maintenance dialysis, 13 on continuous ambulatory peritoneal dialysis, and nine on hemodialysis; nine patients have undergone transplantations, seven died, and two were discharged home on conservative treatment. The outlook for children with chronic renal failure (CRF) has changed over the last two decades, largely due to the advances made in dialysis and organ transplantation. Children who not very long ago would have faced certain death can now be treated and rehabilitated, so that they can become useful members of the society.Epidemiological studies of the disease in children are important in order to plan for their special medical requirements, including dialysis and organ transplant facilities. The subject has been researched and discussed extensively in many countries, but very little information is available from the Kingdom of Saudi Arabia. The purpose of this study was to identify the common causes of CRF, assess the problems related to its treatment, and discuss the therapeutic modalities available locally. Patients and DefinitionsThe study included 100 children with CRF referred to our renal unit from different parts of the Kingdom over the last three years. Neonates who died soon after birth due to severe renal impairment as in Potter's syndrome were excluded from the study. The definitions used were as follows:1,2 chronic renal failure (CRF): irreversible increase of serum creatinine levels to more than 180 µmol/L (2 mg/dl); preterminal renal failure: CRF before reaching terminal renal failure; ter minal renal failure: CRF requiring dialysis or transplantation or leading to death. ResultsFifty-seven (57%) patients were less than 6 years old on admission and this included 22 children younger than a year (Table 1). Seventy-six (76%) children were Saudis and the remaining 24% were children of Arab expatriates

Posterior urethral valves are the most common cause of bladder obstruction in boys. Clinical presentation may vary, depending upon the degree of obstruction and its sequelae. Pathological changes range from relatively normal upper tracts or a small amount of dilatation to a massive dilatation associated with severe infection or sepsis, azotemia and/or renal dysplasia. In our population they constitute about 17% of chronic renal failure in children. 1The development of renal insufficiency in patients with posterior urethral valves may be attributed to the high pressure generated by urethral obstruction transmitted to the upper tracts in utero. In this review, four cases of posterior urethral valves are described, in which we identified certain protective factors which provided a "pop-off" mechanism that resulted in preservation of intact renal and bladder function. Patients and Methods Case 1This infant was born with bilateral abdominal masses and mild respiratory distress. Antenatal ultrasound showed bilateral hydronephrosis and oligohydramnios. The initial serum creatinine was 200 μmol/L. Ultrasonogram showed bilateral hydronephrosis. A large collection of fluid was seen around the superior pole of the right kidney, measuring 4.4 x 3.1 cm. A similarly large collection was seen around the left kidney. A micturating cystourethrogram (MCUG) showed multiple small bladder diverticulae, a long dilated posterior urethra and a right Grade V vesicoureteric reflux (VUR). A DMSA scan showed 6% function in the right kidney and 94% in the left kidney. The baby underwent cystourethroscopy, vesicostomy and drainage of both perinephric urinomas. The serum creatinine reached 75 μmol/L. At the age of two years the vesicostomy was closed and the valve fulgurated. Cystometry showed a normal bladder capacity. Subsequently he underwent a right nephroureterectomy. At his last follow-up at the age of three years, his serum creatinine was 40 μmol/L. Case 2A 45-day-old infant was referred to us with failure to gain weight from birth and repeated vomiting of one week's duration. The abdomen was distended, with well-defined masses palpable in both loin regions. The initial serum creatinine was 190 μmol/L. A sonogram showed hydronephrotic kidneys with hyperechoic parenchyma. A well-defined urinoma was seen on the anteriomedial aspect of the right kidney (2.6 x 1.1 cm). A cystogram showed multiple diverticulae of varying size, a right Grade IV VUR and a dilated posterior urethra. A DMSA scan showed 7% function in the right kidney and 93% in the left kidney. Cystoscopy showed a Type III posterior urethral valve (PUV). A vesicostomy and drainage of the urinoma by a perinephric drain were performed. On the 10th day after admission, the infant's serum creatinine dropped to 54 μmol/L. A repeat ultrasound showed that the urinoma had regressed in size. The vesicostomy was closed and the valve fulgurated. Cystometry showed normal findings for the age. Ultimately, a right nephroureterectomy was performed. At his last follow up at the age of two year...