Children are at a very high risk of various kidney problems, including treatable to long term consequences to life-threatening infections. Acute kidney problems can occur fast and last for a short time but still, have a long term effect on the child. At times it can also go away in entirety once the root problem has been identified and resolved. However, in the cases where the condition is chronic, it might not go away with treatment and might even get worse over time (Rosenfield et al., 1977, 300).A chronic kidney problem might eventually lead to kidney failure that is often seen as the end-stage in any kidney problem. From the time of birth to the age of 4-year, heredity, and defectfrom birth are the primary reasons for the failure of the kidney (Zerres et al., 1998, 138).From the time the child is aged 4 to 15 years, the heredity issues, in addition to systemic disease and nephritic disease, cause much of the kidney problems. Between ages 15 and 19, the glomeruli infections are the most cause of the failure of the kidney, thus making heredity diseases to have less prominence in causing a problem.
To examine the kidney, a process known as renal ultrasonography (Renal US) is used. The process is essential in the diagnosis and the management of the various diseases related to the kidney. The ultrasound can quickly provide a precise examination of the kidney and show most of the pathological changes (Boal and Teele, 1980, 576). The US is a critical process that is inexpensive, accessible, and fast aid in making decisions about patients that have a symptom of renal problems. The procedure uses B-mode imaging to assess the renal anatomy, and the US is applied as the image guidance for the renal interventions. In recent times the application of US with contrast-enhanced ultrasound has helped to make an even more concise analysis of the kidney.
Rationale
The Saudi Arabia Kingdom KSA is a vast country that has a massive concentration of the children population. Children that are aged better 0-14 yeas account for about 29.4% of the country’s population. Besides, the child population growth rate is estimated at 1.54%. Moreover, statistics show that the price to affiliation in the right is high, being at an average of (52-56 % of marriages). The statistics in the population of Saudi Arabia are closely associated withgenetically mediate renal infection. However, there are still other factors that lead to a higher incidence of post-infection. Besides, the lack of awareness among the pediatricians on the need for making an early diagnosis of the bladder that is neurogenic with the lesion in the spinal cord or non-neurotic neurogenic bladder makes the chance of Chronic Kidneydiseases quite high (Ward et al., 2002). The problem is more prevalent in affected children since the conditions might often be only reported at an end-stage. The focus of this article is to review the spectrum of renal pathologies in Saudi pediatrics that use ultrasound.
Research question / OBJECTIVES AND AIMS
Genetically transmitted renal disease constitutes a significant portion of the renal problems in childhood. Some are hereditary that might have a link to the X inheritance, such as the polycystic kidney problem and the Alport’s diseases. There are still other diseases among families that might include siblings thought to be related to genetic predisposition. In the Saudi kingdom, about two-thirds of the marriages are betweencousins. Therefore, there is a high possibility of the transmission of renal problems that have autosomal patterns. It is hard to get the exact prevalence based on the fact that there is very little literatureon the subject since most of the research on the topic is based on the Riyadh region. However, a close look at the data on the prevalence of the infection in the region could help shed some light on the spectrum of renal disease. The focus of the study is to look at the rate of prevalence for each of the various renal conditions and understand the ones that are more prevalent.With the analysis of the causes of the infection, it would be possible to understand whether there is a preference for genetically based diseases or other infections. Therefore, this study aimed to identify the spectrum of renal pathologies in Saudi pediatrics using ultrasound.
Literature Review
Getting a good understanding of the patterns and epidemiology of childhood renal diseases in a critical part in the prevention of chronic kidney problems and thus delay the progression of the problem. However,many of the developing countries have very little data on the preferences of the conditions. A study byKari(2012, 2) tries to look at the prevalence of these conditions in the KSA region. The study finds that the prevalence of the disease in the areas is high and results in about 8% motility (Al-Homrany et al., 2019 628).The study thus reveals a striking problem in the prevalence of the condition in the region. The limitation of the data on renal diseases in the KSA is an issue that Kari (2012, 1) also seeks to explore; she argues that there has been tremendous growth in the nephrology subspecialty in KSA. The pediatric nephrologists are challenges with a different spectrum of renal diseases. However, there is an enormous challenge of the lack of epidemiological studies for most of these diseases.
However, in many of the studies, there has been much more focus only on the prevalence of the condition among children. There has been little research that has focused on creating a link between these infections and genetic characterizes. Several factors have been put forward on the causes of the problems. However, (Alsaggaf, 2013, 67)arguethatgenetically mediated renal disease is high in the KSA region. In the study, it became evident that one of the conditions that are high in the area is post-infection granular pathology (Fallahzadeh and Fallahzadeh 2018. The research shows that the neurogenic bladder thatcauses spinal lesions resulting in chronic kidney infection is also prevalent in the region (Santangelo et al. 2018 130). Some of the tropical diseases have been controlled, but the ones that are genetically caused have not been managed (Jain et al., 1997, 236). The lack of systematic data on the prevalence of the different conditions has not been effectively explored (Maalej et al., 2018). The lack of linkage better the family conditions and the prevalence of the genetically related renal infection could be one of the reasons that make the health more prevalent among the children.
In the study by Akl et al. (2016), there is clear evidence that the prevalence of the conditions is mostly associated with children that are under the age of 14. In the study byAhmed (2019, 180), it becomes apparent that children below the age of 14 are mostly affected by renal diseases that are related to genetic issues (Currarino et al. 1989, 572). Children that are beyond this age are affected by the condition (Leland et al. 1985, 114). The lack of genetic variation in the KSA region would be one of the significant indicators that need to be explored. Al-Agha et al. (2019, 1234) stated that about 52-56% of the population comes from consanguinity marriages (Preminger et al., 1982, 558)Thesestatistics provide an understanding to the reason that many of the renal infection might be passed from one generation to the other (Lucaya et al., 1993, 360). The lack of genetic variability that comes from the marriage with cousins means that most of the conditions might remain within the family (Ali et al., 2019). These studies have thus revealed an essential gap in the linkage between genetic issues and the spectrum of renal infections in the region.
Research Design and Methods
Study Design:
The focus of this review is to use a cross-sectional, retrospective study; there, the research seeks to analyze the outcomes of the subjects retrogressively within 12 months. There are still specific threats are taking into account, including the threats to validity and the measurement errors that came from the retrospective assessment. However, these issues are well addressed in the design, making it more suitable for the cross-sectional study of children in the region. The choice of using this method results from the fact that it isinexpensive and fast. The technique allows for the collection of a large amount of data within a short time. The data would be obtained from a self-report survey that will enable us to deal with a large population.
Study Settings:
The setting of the study explores aRetrospective pattern at the Radiology department of King Fahad Medical City.
Population and Study Sample:
The study population comprises of a total of ≥100 cases of Saudi pediatric patients.
Sample Size and Selection of Sample:
A convenient sampling method was used to include all patients referred for different diagnoses from December 2018 to December 2019). The sample size of 100 cases with various renal pathologies was selected.The Selection criteria only focused on limiting the resultsto include only Saudi pediatrics, as well as from different regions of Saudi Arabia. The Criteria of exclusion were based on the characteristics that children that were beyond the age of 14 were not included. Studies have shown that most of the children beyond the age of 14 are not affected by hereditary renal conditions; therefore, they were excluded from the study. The study did not use the background as one of the exclusion criteria; the focus was that all the children that met the criteria were included in the study.
Collection of Data (Instruments):
The data collection instrument included sheets and different ultrasound machines with B-mode and Doppler modes in the area of the study were utilized to provide the differential results that were later filled into the leaves.
Data Analysis:
Results were analyzed using SPSS software programs, and the layout of the results filled tables and graphs.Descriptive analysis was used to describe patients characteristics and prevalence of renal pathologies
Ethical consideration:
The ethical considerations involved getting approval from the local ethics committee before starting data collection for this project started. The basic requirements for obtaining approval from the various medical facilities were met (Avni et al., 2002, 170). Besides, the participant was given enough information and allowed to give their consent before the start of the study. They informed of the confidentiality of the research and that the findings would only be used for analysis and not any other commercial or social objectives. The participants were required to sign the consent form while participation was on a voluntary basis.
Time frames:
This study was completed in a zone of 12 months from starting the process of the data collection.
IV. Results
Demographic Characteristics
The first characteristic was the demographics that show that the sample population was mostly aged better at the age of 6 years. While the community included a sample of children aged from ages 1 to 14 years, most of the children that were infected were aged between 4 to 7 years. The lowest percentages were from ages 12 to 14. There was thus a clear difference in regards to the ages that the children were mostly affected by renal diseases. Most of the children were at the age of 4-7 years. Besides, the males were at a higher risk as compared to women. From the result, about 60% of males were affected as compared to 20% of females. The last characteristics were regions, and the studies show that children at the center are more affected as compared to the ones that come from the wWest
Table 1. Demographic characteristics of the study sample (n=50).
| Demographic data | Value |
| Age (mean±SD) | 6±3.5 years |
| Age range (years) | 1-14 years |
| Age ranges; n (%) | 1-3, 13 (26%)
4-7, 22 (44%) 8-11, 11 (22%) 12-14, 4 (8%) |
| Male; n (%)
Female; n (%) Male to female ratio |
30 (60%)
20 (40%) 1.5:1 |
| Location in Saudi Arabia
Center; n (%) North; n (%) South; n (%) East; n (%) West; n (%) |
37 (74%) 4 (8%) 6 (12%) 3 (6%) 0 (0%) |
| Family History
Positive; n (%) Negative; n (%) |
8 (16%) 42 (84%) |
The spectrum of renal ultrasound indications in the study sample
The second analysis looks at the ultrasound indication in the study sample. The differential diagnosis shows that there is a significant difference between the different types of infection in the children. The result indicates that the ectopic kidney affected only 1% of the sample, while Hydronephrosis affected about 26% of the sample. Table 2. The spectrum of renal ultrasound indications in the study sample
| Renal US indication | Frequency | Percentage |
| Ectopic kidney | 1 | 2% |
| Hematuria | 1 | 2% |
| Renal cyst for follow up | 1 | 2% |
| Polycystic kidney disease (PCKD) | 1 | 2% |
| pelvic ureteric junction (PUJ) obstruction (not heredity) | 1 | 2% |
| Pyeloplasty | 2 | 4% |
| Bilateral vesicoureteric reflux (VUR) | 3 | 6% |
| Unilateral VUR | 3 | 6% |
| Multicystic dysplastic kidney (MCDK) | 4 | 8% |
| Neurogenic urinary bladder (UB) | 5 | 10% |
| Loin pain | 7 | 14% |
| Recurrent urinary tract infection (UTI) | 8 | 16% |
| Hydronephrosis for follow up | 13 | 26% |
Pathologies detected in the right kidney of scanned samples
The third analysis looked at the pathologies in the right organ of the digitized samples. The results show that in the right kidney, MCDK had the lowest pathological result. On the other hand, hydronephrosis was more prevalent in the right kidney. However, there was a variation in regards to Hydronephrosis, where the mill hydronephrosis was highly detected. However, about 54% of the right kidney showed typical signs. However, as compared to the right kidney, it emerged that the left kidney was more affected. While the right kidney was 54% normal, the left kidney was only 40% normal.
Table 3. Pathologies detected in the right kidney of scanned samples
| B-mode findings in the Rt kidney of examined patients | Frequency (n) | Percentage (%) |
| MCDK | 1 | 2% |
| Simple cystic mass | 1 | 2% |
| Renal calculi | 1 | 2% |
| PCKD | 1 | 2% |
| Renal agenesis | 2 | 4% |
| Simple cortical cyst | 2 | 4% |
| Bilateral nephrocalcinosis | 3 | 6% |
| Moderate hydronephrosis | 6 | 12% |
| Mild Hydronephrosis | 6 | 12% |
| Normal | 27 | 54% |
| B-mode findings in the Lt kidney of examined patients | Frequency (n) | Percentage (%) |
| PCKD | 1 | 2% |
| Ectopic kidney | 2 | 4% |
| MCDK | 3 | 6% |
| bilateral nephrocalcinosis | 3 | 6% |
| Severe Hydronephrosis | 5 | 10% |
| Moderate hydronephrosis | 7 | 14% |
| Mild Hydronephrosis | 9 | 18% |
| Normal | 20 | 40% |
Discussions
The demographic characteristics revealed that the age of the child had a severe impact on the prevalence of renal infection. Therefore, the renal spectrum is profoundly affected by the age of the children. The children that were aged between 4 to seven years, most at risk while the one aged between 12 to 14 years had the least chance. Besides, the location of the child had an impact on their prevalence of infection. The children from the center were at higher chances as compared to the children in the WeWestLastly; the sex of the children was an important factor in the prevalence. Males were at a higher risk as compared to females. Besides, the family history did not have much impact on the spectrum. The family history had only a 16% positive impact, while 84 of the sample show a negative response.
From the result of the spectrum, it emerged that there was a difference in the prevalence levels between various infections. The results showed the ectopic kindly only affected two decent of the sample. This was in contrast to Hydronephrosis that affected about 26% of the sample. This result thus shows that some infection has more prevalence as compared to others. Of much importance is the cause of these infections. Our hypothesis sought to understand the relationship between the various renal diseases and their purpose. We tried to look at the link between genetically liked renal infections and kindly problems. However, from the study, it becomes evident that most of the infections that are genetically linked do not have more prevalence in the spectrum, for instance, an ectopic kidney that is genetics has the lowest prevalence in the range. Beside, recurrent urinary tract infection that is not genetically linked has a high incidence of 26%.
Concussion
From the findings, it becomes evident that there are variations in the prevalence of renal pathologies in pediatrics using ultrasound. However, no evidence shows that there is a link better genetically linked pathologies and kidney infections. The studies have shown that win Saudi most of the genetically related pathologies does not have a higher prevalence as compared to the ones that are not genetically linked. In fact, most of the genetically related pathologies have a very low incidence, yet the ones that do not have a high prevalence.
Bibliography
Ahmed, H.G., Alzayed, F.S.M., Ali, H.K., Albluwe, ZASA, Aljarallah, M.Y.J., Alghazi, B.K.M. and Alshammari, M.A.G., 2019. Etiology of Chronic Kidney Disease (CKD) in Saudi Arabia. Health Sciences, 8(5), pp.177-182.
Akl, K.F., Albaramki, J.H., Hazza, I., Haddidi, R., Saleh, S.H., Haddad, R., Ajarmeh, S., Al-Assaf, R.S. and Al-Qadi, E., 2016.Aetiology of Paediatric End-stage Renal Failure in Jordan: A Multicentre Study. West Indian Medical Journal, 65(2).
Al-Agha, A.E., Alnawab, A.M. and Hejazi, TM, 2016.Diverse etiology of hyperlipidemia among hospitalized children in Western region of Saudi Arabia. Saudi medical journal, 37(11), p.1234.
Al-Homrany, M., Alghamdi, S., Al-Hwiesh, A., Mousa, D., Alwakeel, J., Mitwalli, A., Alsaad, K., Alharbi, A. and Kari, J., 2019.Pattern of renal diseases and the need for establishment of renal biopsy registry in Saudi Arabia. Saudi Journal of Kidney Diseases and Transplantation, 30(3), p.628.
Ali, S.H., Ali, A.T. and Hasan, A.A., 2019. Etiology of Chronic Kidney Disease in Children in Three pediatric Nephrology Centers in Baghdad. Int. J. Curr. Microbiol.App. Sci, 8(1), pp.1547-1555.
Alsaggaf, H.M., 2013. Pattern of Renal Diseases in Children Presented to King Abdulaziz University Hospital. Journal of King Abdulaziz University-Medical Sciences, 20(3), pp.67-78.
Avni, F.E., Guissard, G., Hall, M., Janssen, F., DeMaertelaer, V. and Rypens, F., 2002. Hereditary polycystic kidney diseases in children: changing sonographic patterns through childhood. Pediatric radiology, 32(3), pp.169-174.
Boal, D.K. and Teele, R.L., 1980.Sonography of infantile polycystic kidney disease. American Journal of Roentgenology, 135(3), pp.575-580.
Currarino, G., Stannard, M.W. and Rutledge, J.C., 1989. The sonolucent cortical rim in infantile polycystic kidneys.Histologic correlation. Journal of ultrasound in medicine, 8(10), pp.571-574.
Fallahzadeh, M.H. and Fallahzadeh, M.A., 2018. On the occasion of world kidney day 2016; renal disease in children. ActaPersicaPathophysiologica, 1.
Jain, M., LeQuesne, G.W., Bourne, A.J. and Henning, P., 1997. High‐resolution ultrasonography in the differential diagnosis of cystic diseases of the kidney in infancy and childhood: preliminary experience. Journal of ultrasound in medicine, 16(4), pp.235-240.
Kari, J.A., 2012. Pediatric renal diseases in the Kingdom of Saudi Arabia. World Journal of Pediatrics, 8(3), pp.217-221.
Leland Melson, G., Shackelford, G.D., Cole, B.R. and McClennan, BL, 1985. spectrum of sonographic findings in infantile polycystic kidney disease with urographic and clinical correlations. Journal of clinical ultrasound, 13(2), pp.113-119.
Lucaya, J., Enriquez, G., Nieto, J., Callis, L., Garcia Peña, P. and Dominguez, C., 1993. Renal calcifications in patients with autosomal recessive polycystic kidney disease: prevalence and cause. AJR.American journal of roentgenology, 160(2), pp.359-362.
Maalej, B., Louati, H., Guirat, R., Wali, M. and Abid, H., 2018. Childhood Chronic Kidney Disease: Experience of a Pediatric Department. J NephrolUrol, 2(1), p.1.
Preminger, G.M., Koch, W.E., Fried, F.A., McFarland, E., Murphy, E.D. and Mandell, J., 1982. Murine congenital polycystic kidney disease: a model for studying development of cystic disease. The Journal of urology, 127(3), pp.556-560.
Rosenfield, A.T., Siegel, N.J., Kappelman, N.B. and Taylor, K.J., 1977.Gray scale ultrasonography in medullary cystic disease of the kidney and congenital hepatic fibrosis with tubular ectasia: new observations. American Journal of Roentgenology, 129(2), pp.297-303.
Santangelo, L., Netti, G.S., Giordano, P., Carbone, V., Martino, M., Torres, D.D., Rossini, M., Di Palma, A.M., Gesualdo, L. and Giordano, M., 2018. Indications and results of renal biopsy in children: a 36-year experience. World Journal of Pediatrics, 14(2), pp.127-133.
Ward, C.J., Hogan, M.C., Rossetti, S., Walker, D., Sneddon, T., Wang, X., Kubly, V., Cunningham, J.M., Bacallao, R., Ishibashi, M. and Milliner, D.S., 2002. The gene mutated in autosomal recessive polycystic kidney disease encodes a large, receptor-like protein. Nature genetics, 30(3), pp.259-269.
Zerres, K., Mücher, G., Becker, J., Steinkamm, C., Rudnik‐Schöneborn, S., Heikkilä, P., Rapola, J., Salonen, R., Germino, G.G., Onuchic, L. and Somlo, S., 1998. Prenatal diagnosis of autosomal recessive polycystic kidney disease (ARPKD): molecular genetics, clinical experience, and fetal morphology. American journal of medical genetics, 76(2), pp.137-144.
Appendixes
Table 1. Demographic characteristics of the study sample (n=50).
| Demographic data | Value |
| Age (mean±SD) | 6±3.5 years |
| Age range (years) | 1-14 years |
| Age ranges; n (%) | 1-3, 13 (26%)
4-7, 22 (44%) 8-11, 11 (22%) 12-14, 4 (8%) |
| Male; n (%)
Female; n (%) Male to female ratio |
30 (60%)
20 (40%) 1.5:1 |
| Location in Saudi Arabia
Center; n (%) North; n (%) South; n (%) East; n (%) West; n (%) |
37 (74%) 4 (8%) 6 (12%) 3 (6%) 0 (0%) |
| Family History
Positive; n (%) Negative; n (%) |
8 (16%) 42 (84%) |
Table 2.Spectrum of renal ultrasound indications in the study sample
| Renal US indication | Frequency | Percentage |
| Ectopic kidney | 1 | 2% |
| Hematuria | 1 | 2% |
| Renal cyst for follow up | 1 | 2% |
| Polycystic kidney disease (PCKD) | 1 | 2% |
| pelviureteric junction (PUJ) obstruction | 1 | 2% |
| Pyeloplasty | 2 | 4% |
| Bilateral vesicoureteric reflux (VUR) | 3 | 6% |
| Unilateral VUR | 3 | 6% |
| Multicystic dysplastic kidney (MCDK) | 4 | 8% |
| Neurogenic urinary bladder (UB) | 5 | 10% |
| Loin pain | 7 | 14% |
| Recurrent urinary tract infection (UTI) | 8 | 16% |
| Hydronephrosis for follow up | 13 | 26% |
Figure 1.Spectrum of renal ultrasound indications in the study sample.
Table 3. Pathologies detected in the right kidney of scanned samples
| B-mode findings in the Rt kidney of examined patients | Frequency (n) | Percentage (%) |
| MCDK | 1 | 2% |
| Simple cystic mass | 1 | 2% |
| Renal calculi | 1 | 2% |
| PCKD | 1 | 2% |
| Renal agenesis | 2 | 4% |
| Simple cortical cyst | 2 | 4% |
| Bilateral nephrocalcinosis | 3 | 6% |
| Moderate hydronehrosis | 6 | 12% |
| Mild Hydronephrosis | 6 | 12% |
| Normal | 27 | 54% |
Figure 2. Pathologies detected in the right kidney of scanned samples.
| B-mode findings in the Lt kidney of examined patients | Frequency (n) | Percentage (%) |
| PCKD | 1 | 2% |
| Ectopic kidney | 2 | 4% |
| MCDK | 3 | 6% |
| bilateral nephrocalcinosis | 3 | 6% |
| Severe Hydronephrosis | 5 | 10% |
| Moderate hydronehrosis | 7 | 14% |
| Mild Hydronephrosis | 9 | 18% |
| Normal | 20 | 40% |
Figure 3.Pathologies detected in the left kidney of scanned samples.
| Status of blood uptake regarding color Doppler | Color Doppler findings in the Rt kidney; n (%) | Color Doppler findings in the Rt kidney; n (%) |
| Normal color Uptake | 45 | 36 |
| Decrease color uptake | 2 | 11 |
| No vascularity | 3 | 3 |
Figure 4.Status of kidneys blood uptake regarding color Doppler in the scanned sample.
Children are at a very high risk of various kidney problems, including treatable to long term consequences to life-threatening infections. Acute kidney problems can occur fast and last for a short time but still, have a long term effect on the child. At times it can also go away in entirety once the root problem has been identified and resolved. However, in the cases where the condition is chronic, it might not go away with treatment and might even get worse over time (Rosenfield et al., 1977, 300).A chronic kidney problem might eventually lead to kidney failure that is often seen as the end-stage in any kidney problem. From the time of birth to the age of 4-year, heredity, and defectfrom birth are the primary reasons for the failure of the kidney (Zerres et al., 1998, 138).From the time the child is aged 4 to 15 years, the heredity issues, in addition to systemic disease and nephritic disease, cause much of the kidney problems. Between ages 15 and 19, the glomeruli infections are the most cause of the failure of the kidney, thus making heredity diseases to have less prominence in causing a problem.
To examine the kidney, a process known as renal ultrasonography (Renal US) is used. The process is essential in the diagnosis and the management of the various diseases related to the kidney. The ultrasound can quickly provide a precise examination of the kidney and show most of the pathological changes (Boal and Teele, 1980, 576). The US is a critical process that is inexpensive, accessible, and fast aid in making decisions about patients that have a symptom of renal problems. The procedure uses B-mode imaging to assess the renal anatomy, and the US is applied as the image guidance for the renal interventions. In recent times the application of US with contrast-enhanced ultrasound has helped to make an even more concise analysis of the kidney.
Rationale
The Saudi Arabia Kingdom KSA is a vast country that has a massive concentration of the children population. Children that are aged better 0-14 yeas account for about 29.4% of the country’s population. Besides, the child population growth rate is estimated at 1.54%. Moreover, statistics show that the price to affiliation in the right is high, being at an average of (52-56 % of marriages). The statistics in the population of Saudi Arabia are closely associated withgenetically mediate renal infection. However, there are still other factors that lead to a higher incidence of post-infection. Besides, the lack of awareness among the pediatricians on the need for making an early diagnosis of the bladder that is neurogenic with the lesion in the spinal cord or non-neurotic neurogenic bladder makes the chance of Chronic Kidneydiseases quite high (Ward et al., 2002). The problem is more prevalent in affected children since the conditions might often be only reported at an end-stage. The focus of this article is to review the spectrum of renal pathologies in Saudi pediatrics that use ultrasound.
Research question / OBJECTIVES AND AIMS
Genetically transmitted renal disease constitutes a significant portion of the renal problems in childhood. Some are hereditary that might have a link to the X inheritance, such as the polycystic kidney problem and the Alport’s diseases. There are still other diseases among families that might include siblings thought to be related to genetic predisposition. In the Saudi kingdom, about two-thirds of the marriages are betweencousins. Therefore, there is a high possibility of the transmission of renal problems that have autosomal patterns. It is hard to get the exact prevalence based on the fact that there is very little literatureon the subject since most of the research on the topic is based on the Riyadh region. However, a close look at the data on the prevalence of the infection in the region could help shed some light on the spectrum of renal disease. The focus of the study is to look at the rate of prevalence for each of the various renal conditions and understand the ones that are more prevalent.With the analysis of the causes of the infection, it would be possible to understand whether there is a preference for genetically based diseases or other infections. Therefore, this study aimed to identify the spectrum of renal pathologies in Saudi pediatrics using ultrasound.
Literature Review
Getting a good understanding of the patterns and epidemiology of childhood renal diseases in a critical part in the prevention of chronic kidney problems and thus delay the progression of the problem. However,many of the developing countries have very little data on the preferences of the conditions. A study byKari(2012, 2) tries to look at the prevalence of these conditions in the KSA region. The study finds that the prevalence of the disease in the areas is high and results in about 8% motility (Al-Homrany et al., 2019 628).The study thus reveals a striking problem in the prevalence of the condition in the region. The limitation of the data on renal diseases in the KSA is an issue that Kari (2012, 1) also seeks to explore; she argues that there has been tremendous growth in the nephrology subspecialty in KSA. The pediatric nephrologists are challenges with a different spectrum of renal diseases. However, there is an enormous challenge of the lack of epidemiological studies for most of these diseases.
However, in many of the studies, there has been much more focus only on the prevalence of the condition among children. There has been little research that has focused on creating a link between these infections and genetic characterizes. Several factors have been put forward on the causes of the problems. However, (Alsaggaf, 2013, 67)arguethatgenetically mediated renal disease is high in the KSA region. In the study, it became evident that one of the conditions that are high in the area is post-infection granular pathology (Fallahzadeh and Fallahzadeh 2018. The research shows that the neurogenic bladder thatcauses spinal lesions resulting in chronic kidney infection is also prevalent in the region (Santangelo et al. 2018 130). Some of the tropical diseases have been controlled, but the ones that are genetically caused have not been managed (Jain et al., 1997, 236). The lack of systematic data on the prevalence of the different conditions has not been effectively explored (Maalej et al., 2018). The lack of linkage better the family conditions and the prevalence of the genetically related renal infection could be one of the reasons that make the health more prevalent among the children.
In the study by Akl et al. (2016), there is clear evidence that the prevalence of the conditions is mostly associated with children that are under the age of 14. In the study byAhmed (2019, 180), it becomes apparent that children below the age of 14 are mostly affected by renal diseases that are related to genetic issues (Currarino et al. 1989, 572). Children that are beyond this age are affected by the condition (Leland et al. 1985, 114). The lack of genetic variation in the KSA region would be one of the significant indicators that need to be explored. Al-Agha et al. (2019, 1234) stated that about 52-56% of the population comes from consanguinity marriages (Preminger et al., 1982, 558)Thesestatistics provide an understanding to the reason that many of the renal infection might be passed from one generation to the other (Lucaya et al., 1993, 360). The lack of genetic variability that comes from the marriage with cousins means that most of the conditions might remain within the family (Ali et al., 2019). These studies have thus revealed an essential gap in the linkage between genetic issues and the spectrum of renal infections in the region.
Research Design and Methods
Study Design:
The focus of this review is to use a cross-sectional, retrospective study; there, the research seeks to analyze the outcomes of the subjects retrogressively within 12 months. There are still specific threats are taking into account, including the threats to validity and the measurement errors that came from the retrospective assessment. However, these issues are well addressed in the design, making it more suitable for the cross-sectional study of children in the region. The choice of using this method results from the fact that it isinexpensive and fast. The technique allows for the collection of a large amount of data within a short time. The data would be obtained from a self-report survey that will enable us to deal with a large population.
Study Settings:
The setting of the study explores aRetrospective pattern at the Radiology department of King Fahad Medical City.
Population and Study Sample:
The study population comprises of a total of ≥100 cases of Saudi pediatric patients.
Sample Size and Selection of Sample:
A convenient sampling method was used to include all patients referred for different diagnoses from December 2018 to December 2019). The sample size of 100 cases with various renal pathologies was selected.The Selection criteria only focused on limiting the resultsto include only Saudi pediatrics, as well as from different regions of Saudi Arabia. The Criteria of exclusion were based on the characteristics that children that were beyond the age of 14 were not included. Studies have shown that most of the children beyond the age of 14 are not affected by hereditary renal conditions; therefore, they were excluded from the study. The study did not use the background as one of the exclusion criteria; the focus was that all the children that met the criteria were included in the study.
Collection of Data (Instruments):
The data collection instrument included sheets and different ultrasound machines with B-mode and Doppler modes in the area of the study were utilized to provide the differential results that were later filled into the leaves.
Data Analysis:
Results were analyzed using SPSS software programs, and the layout of the results filled tables and graphs.Descriptive analysis was used to describe patients characteristics and prevalence of renal pathologies
Ethical consideration:
The ethical considerations involved getting approval from the local ethics committee before starting data collection for this project started. The basic requirements for obtaining approval from the various medical facilities were met (Avni et al., 2002, 170). Besides, the participant was given enough information and allowed to give their consent before the start of the study. They informed of the confidentiality of the research and that the findings would only be used for analysis and not any other commercial or social objectives. The participants were required to sign the consent form while participation was on a voluntary basis.
Time frames:
This study was completed in a zone of 12 months from starting the process of the data collection.
IV. Results
Demographic Characteristics
The first characteristic was the demographics that show that the sample population was mostly aged better at the age of 6 years. While the community included a sample of children aged from ages 1 to 14 years, most of the children that were infected were aged between 4 to 7 years. The lowest percentages were from ages 12 to 14. There was thus a clear difference in regards to the ages that the children were mostly affected by renal diseases. Most of the children were at the age of 4-7 years. Besides, the males were at a higher risk as compared to women. From the result, about 60% of males were affected as compared to 20% of females. The last characteristics were regions, and the studies show that children at the center are more affected as compared to the ones that come from the wWest
Table 1. Demographic characteristics of the study sample (n=50).
| Demographic data | Value |
| Age (mean±SD) | 6±3.5 years |
| Age range (years) | 1-14 years |
| Age ranges; n (%) | 1-3, 13 (26%)
4-7, 22 (44%) 8-11, 11 (22%) 12-14, 4 (8%) |
| Male; n (%)
Female; n (%) Male to female ratio |
30 (60%)
20 (40%) 1.5:1 |
| Location in Saudi Arabia
Center; n (%) North; n (%) South; n (%) East; n (%) West; n (%) |
37 (74%) 4 (8%) 6 (12%) 3 (6%) 0 (0%) |
| Family History
Positive; n (%) Negative; n (%) |
8 (16%) 42 (84%) |
The spectrum of renal ultrasound indications in the study sample
The second analysis looks at the ultrasound indication in the study sample. The differential diagnosis shows that there is a significant difference between the different types of infection in the children. The result indicates that the ectopic kidney affected only 1% of the sample, while Hydronephrosis affected about 26% of the sample. Table 2. The spectrum of renal ultrasound indications in the study sample
| Renal US indication | Frequency | Percentage |
| Ectopic kidney | 1 | 2% |
| Hematuria | 1 | 2% |
| Renal cyst for follow up | 1 | 2% |
| Polycystic kidney disease (PCKD) | 1 | 2% |
| pelvic ureteric junction (PUJ) obstruction (not heredity) | 1 | 2% |
| Pyeloplasty | 2 | 4% |
| Bilateral vesicoureteric reflux (VUR) | 3 | 6% |
| Unilateral VUR | 3 | 6% |
| Multicystic dysplastic kidney (MCDK) | 4 | 8% |
| Neurogenic urinary bladder (UB) | 5 | 10% |
| Loin pain | 7 | 14% |
| Recurrent urinary tract infection (UTI) | 8 | 16% |
| Hydronephrosis for follow up | 13 | 26% |
Pathologies detected in the right kidney of scanned samples
The third analysis looked at the pathologies in the right organ of the digitized samples. The results show that in the right kidney, MCDK had the lowest pathological result. On the other hand, hydronephrosis was more prevalent in the right kidney. However, there was a variation in regards to Hydronephrosis, where the mill hydronephrosis was highly detected. However, about 54% of the right kidney showed typical signs. However, as compared to the right kidney, it emerged that the left kidney was more affected. While the right kidney was 54% normal, the left kidney was only 40% normal.
Table 3. Pathologies detected in the right kidney of scanned samples
| B-mode findings in the Rt kidney of examined patients | Frequency (n) | Percentage (%) |
| MCDK | 1 | 2% |
| Simple cystic mass | 1 | 2% |
| Renal calculi | 1 | 2% |
| PCKD | 1 | 2% |
| Renal agenesis | 2 | 4% |
| Simple cortical cyst | 2 | 4% |
| Bilateral nephrocalcinosis | 3 | 6% |
| Moderate hydronephrosis | 6 | 12% |
| Mild Hydronephrosis | 6 | 12% |
| Normal | 27 | 54% |
| B-mode findings in the Lt kidney of examined patients | Frequency (n) | Percentage (%) |
| PCKD | 1 | 2% |
| Ectopic kidney | 2 | 4% |
| MCDK | 3 | 6% |
| bilateral nephrocalcinosis | 3 | 6% |
| Severe Hydronephrosis | 5 | 10% |
| Moderate hydronephrosis | 7 | 14% |
| Mild Hydronephrosis | 9 | 18% |
| Normal | 20 | 40% |
Discussions
The demographic characteristics revealed that the age of the child had a severe impact on the prevalence of renal infection. Therefore, the renal spectrum is profoundly affected by the age of the children. The children that were aged between 4 to seven years, most at risk while the one aged between 12 to 14 years had the least chance. Besides, the location of the child had an impact on their prevalence of infection. The children from the center were at higher chances as compared to the children in the WeWestLastly; the sex of the children was an important factor in the prevalence. Males were at a higher risk as compared to females. Besides, the family history did not have much impact on the spectrum. The family history had only a 16% positive impact, while 84 of the sample show a negative response.
From the result of the spectrum, it emerged that there was a difference in the prevalence levels between various infections. The results showed the ectopic kindly only affected two decent of the sample. This was in contrast to Hydronephrosis that affected about 26% of the sample. This result thus shows that some infection has more prevalence as compared to others. Of much importance is the cause of these infections. Our hypothesis sought to understand the relationship between the various renal diseases and their purpose. We tried to look at the link between genetically liked renal infections and kindly problems. However, from the study, it becomes evident that most of the infections that are genetically linked do not have more prevalence in the spectrum, for instance, an ectopic kidney that is genetics has the lowest prevalence in the range. Beside, recurrent urinary tract infection that is not genetically linked has a high incidence of 26%.
Concussion
From the findings, it becomes evident that there are variations in the prevalence of renal pathologies in pediatrics using ultrasound. However, no evidence shows that there is a link better genetically linked pathologies and kidney infections. The studies have shown that win Saudi most of the genetically related pathologies does not have a higher prevalence as compared to the ones that are not genetically linked. In fact, most of the genetically related pathologies have a very low incidence, yet the ones that do not have a high prevalence.
Bibliography
Ahmed, H.G., Alzayed, F.S.M., Ali, H.K., Albluwe, ZASA, Aljarallah, M.Y.J., Alghazi, B.K.M. and Alshammari, M.A.G., 2019. Etiology of Chronic Kidney Disease (CKD) in Saudi Arabia. Health Sciences, 8(5), pp.177-182.
Akl, K.F., Albaramki, J.H., Hazza, I., Haddidi, R., Saleh, S.H., Haddad, R., Ajarmeh, S., Al-Assaf, R.S. and Al-Qadi, E., 2016.Aetiology of Paediatric End-stage Renal Failure in Jordan: A Multicentre Study. West Indian Medical Journal, 65(2).
Al-Agha, A.E., Alnawab, A.M. and Hejazi, TM, 2016.Diverse etiology of hyperlipidemia among hospitalized children in Western region of Saudi Arabia. Saudi medical journal, 37(11), p.1234.
Al-Homrany, M., Alghamdi, S., Al-Hwiesh, A., Mousa, D., Alwakeel, J., Mitwalli, A., Alsaad, K., Alharbi, A. and Kari, J., 2019.Pattern of renal diseases and the need for establishment of renal biopsy registry in Saudi Arabia. Saudi Journal of Kidney Diseases and Transplantation, 30(3), p.628.
Ali, S.H., Ali, A.T. and Hasan, A.A., 2019. Etiology of Chronic Kidney Disease in Children in Three pediatric Nephrology Centers in Baghdad. Int. J. Curr. Microbiol.App. Sci, 8(1), pp.1547-1555.
Alsaggaf, H.M., 2013. Pattern of Renal Diseases in Children Presented to King Abdulaziz University Hospital. Journal of King Abdulaziz University-Medical Sciences, 20(3), pp.67-78.
Avni, F.E., Guissard, G., Hall, M., Janssen, F., DeMaertelaer, V. and Rypens, F., 2002. Hereditary polycystic kidney diseases in children: changing sonographic patterns through childhood. Pediatric radiology, 32(3), pp.169-174.
Boal, D.K. and Teele, R.L., 1980.Sonography of infantile polycystic kidney disease. American Journal of Roentgenology, 135(3), pp.575-580.
Currarino, G., Stannard, M.W. and Rutledge, J.C., 1989. The sonolucent cortical rim in infantile polycystic kidneys.Histologic correlation. Journal of ultrasound in medicine, 8(10), pp.571-574.
Fallahzadeh, M.H. and Fallahzadeh, M.A., 2018. On the occasion of world kidney day 2016; renal disease in children. ActaPersicaPathophysiologica, 1.
Jain, M., LeQuesne, G.W., Bourne, A.J. and Henning, P., 1997. High‐resolution ultrasonography in the differential diagnosis of cystic diseases of the kidney in infancy and childhood: preliminary experience. Journal of ultrasound in medicine, 16(4), pp.235-240.
Kari, J.A., 2012. Pediatric renal diseases in the Kingdom of Saudi Arabia. World Journal of Pediatrics, 8(3), pp.217-221.
Leland Melson, G., Shackelford, G.D., Cole, B.R. and McClennan, BL, 1985. spectrum of sonographic findings in infantile polycystic kidney disease with urographic and clinical correlations. Journal of clinical ultrasound, 13(2), pp.113-119.
Lucaya, J., Enriquez, G., Nieto, J., Callis, L., Garcia Peña, P. and Dominguez, C., 1993. Renal calcifications in patients with autosomal recessive polycystic kidney disease: prevalence and cause. AJR.American journal of roentgenology, 160(2), pp.359-362.
Maalej, B., Louati, H., Guirat, R., Wali, M. and Abid, H., 2018. Childhood Chronic Kidney Disease: Experience of a Pediatric Department. J NephrolUrol, 2(1), p.1.
Preminger, G.M., Koch, W.E., Fried, F.A., McFarland, E., Murphy, E.D. and Mandell, J., 1982. Murine congenital polycystic kidney disease: a model for studying development of cystic disease. The Journal of urology, 127(3), pp.556-560.
Rosenfield, A.T., Siegel, N.J., Kappelman, N.B. and Taylor, K.J., 1977.Gray scale ultrasonography in medullary cystic disease of the kidney and congenital hepatic fibrosis with tubular ectasia: new observations. American Journal of Roentgenology, 129(2), pp.297-303.
Santangelo, L., Netti, G.S., Giordano, P., Carbone, V., Martino, M., Torres, D.D., Rossini, M., Di Palma, A.M., Gesualdo, L. and Giordano, M., 2018. Indications and results of renal biopsy in children: a 36-year experience. World Journal of Pediatrics, 14(2), pp.127-133.
Ward, C.J., Hogan, M.C., Rossetti, S., Walker, D., Sneddon, T., Wang, X., Kubly, V., Cunningham, J.M., Bacallao, R., Ishibashi, M. and Milliner, D.S., 2002. The gene mutated in autosomal recessive polycystic kidney disease encodes a large, receptor-like protein. Nature genetics, 30(3), pp.259-269.
Zerres, K., Mücher, G., Becker, J., Steinkamm, C., Rudnik‐Schöneborn, S., Heikkilä, P., Rapola, J., Salonen, R., Germino, G.G., Onuchic, L. and Somlo, S., 1998. Prenatal diagnosis of autosomal recessive polycystic kidney disease (ARPKD): molecular genetics, clinical experience, and fetal morphology. American journal of medical genetics, 76(2), pp.137-144.
Appendixes
Table 1. Demographic characteristics of the study sample (n=50).
| Demographic data | Value |
| Age (mean±SD) | 6±3.5 years |
| Age range (years) | 1-14 years |
| Age ranges; n (%) | 1-3, 13 (26%)
4-7, 22 (44%) 8-11, 11 (22%) 12-14, 4 (8%) |
| Male; n (%)
Female; n (%) Male to female ratio |
30 (60%)
20 (40%) 1.5:1 |
| Location in Saudi Arabia
Center; n (%) North; n (%) South; n (%) East; n (%) West; n (%) |
37 (74%) 4 (8%) 6 (12%) 3 (6%) 0 (0%) |
| Family History
Positive; n (%) Negative; n (%) |
8 (16%) 42 (84%) |
Table 2.Spectrum of renal ultrasound indications in the study sample
| Renal US indication | Frequency | Percentage |
| Ectopic kidney | 1 | 2% |
| Hematuria | 1 | 2% |
| Renal cyst for follow up | 1 | 2% |
| Polycystic kidney disease (PCKD) | 1 | 2% |
| pelviureteric junction (PUJ) obstruction | 1 | 2% |
| Pyeloplasty | 2 | 4% |
| Bilateral vesicoureteric reflux (VUR) | 3 | 6% |
| Unilateral VUR | 3 | 6% |
| Multicystic dysplastic kidney (MCDK) | 4 | 8% |
| Neurogenic urinary bladder (UB) | 5 | 10% |
| Loin pain | 7 | 14% |
| Recurrent urinary tract infection (UTI) | 8 | 16% |
| Hydronephrosis for follow up | 13 | 26% |
Figure 1.Spectrum of renal ultrasound indications in the study sample.
Table 3. Pathologies detected in the right kidney of scanned samples
| B-mode findings in the Rt kidney of examined patients | Frequency (n) | Percentage (%) |
| MCDK | 1 | 2% |
| Simple cystic mass | 1 | 2% |
| Renal calculi | 1 | 2% |
| PCKD | 1 | 2% |
| Renal agenesis | 2 | 4% |
| Simple cortical cyst | 2 | 4% |
| Bilateral nephrocalcinosis | 3 | 6% |
| Moderate hydronehrosis | 6 | 12% |
| Mild Hydronephrosis | 6 | 12% |
| Normal | 27 | 54% |
Figure 2. Pathologies detected in the right kidney of scanned samples.
| B-mode findings in the Lt kidney of examined patients | Frequency (n) | Percentage (%) |
| PCKD | 1 | 2% |
| Ectopic kidney | 2 | 4% |
| MCDK | 3 | 6% |
| bilateral nephrocalcinosis | 3 | 6% |
| Severe Hydronephrosis | 5 | 10% |
| Moderate hydronehrosis | 7 | 14% |
| Mild Hydronephrosis | 9 | 18% |
| Normal | 20 | 40% |
Figure 3.Pathologies detected in the left kidney of scanned samples.
| Status of blood uptake regarding color Doppler | Color Doppler findings in the Rt kidney; n (%) | Color Doppler findings in the Rt kidney; n (%) |
| Normal color Uptake | 45 | 36 |
| Decrease color uptake | 2 | 11 |
| No vascularity | 3 | 3 |
Figure 4.Status of kidneys blood uptake regarding color Doppler in the scanned sample.
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