Background: The etiology of End Stage Renal Disease (ESRD) in every community differs according to genetic, nutrition, and public health status. ESRD, the terminal stage of chronic renal failure, needs replacement therapy otherwise could lead to death.The aim of the study is to determine the relative frequency of ESRD etiology in hemodialysis patients of Gilan province.Methods: This descriptive study was performed on 407 patients who were being hemodialysisin all hemodialysis centers of the Gilan province from September 2002 to September 2003. The original data was collected from the medical records of patients.Results: The most prevalent causes were: hypertension 35.4%; unknown etiology 16.2%; diabetes mellitus 13.8%, glomerulopathies 9.6%, urologic causes 9.1%, cystic kidney diseases 7.6 %; other causes 5.9 %; congenital 2.5%.Conclusion: In our study hypertension was the first etiology of ESRD, followed by unknown causes, however nephrology textbooks indicate diabetes mellitus as the primary and hypertension as the secondary etiology of ESRD.

Background: Chronic renal failure defines as progressive and irreversible dysfunction of kidneys that could eventually terminated to end stage renal disease (GFR<10% NL).Because of therapeutic problem and high mortality and morbidity and it "s implication quality of life , ESRD is one of the important dilemma of pediatric medicine .Materials and Methods: In our study 216 patients evaluated . Results: Male to female ratio was 1.1 . The peak of the presenting age of ESRD was 10 years old (8-12 y). Congenital urological malformation (30%) , glomerulopathies (20%) , hereditary nephropathies (14.3%) , multisystem diseases (7%) and nephrolithiasis (6.2%) are the most common etiologies of ESRD . VUR in 21% and congenital obstructive disease in 8.5% are the etiology of ESRD. In patients with age five years old and lesser common causes of ESRD are congenital urologic malformation and glomerulopathies. In other age groups , urologic malformation is the most common cause of ESRD. In etiologic assessment of two separate 7 years interval , (1988-1993) and (1996-2003) , there was not any significant change in frequency of etiologies but frequency of congenital obstructive uropathy decreased from 10 % to 5.7%. Total amount of VUR (VUR ± Neuropathic bladder) has not any change but frequency of primary reflux nephropathy decreased from 14.2% to 8%. In this study , in 145 patients hemodialysis continued and 28 cases had unsuccessful renal transplant (13.8%) . 7.4 % of patients had successful renal replacement therapy (RRT) and mortality rate was 7.4% . B Conclusion: Based on that the most common cause of ESRD is all ages in congenital urologic malformations , early diagnosis and appropriate management of these cases are effective in decreasing incidence of ESRD and with respect to few cases of renal transplant and unsuccessful results in 65% of RRT , the approach of this problem should be revised.

Dear Editor, Anemia is a common complication of chronic kidney disease (CKD) and can appear before uremic syndrome when the glomerular filtration rate (GFR) decreases to less than 30 mL/min. A low level of hemoglobin (Hb) is an independent risk factor for low quality of life inCKDpatients. Untreated anemia in CKD patients leads to several physiological abnormalities such as impaired heart function, decreased cognation and mental activity, hemostatic dysfunction, impaired immune function and sexual function. Clinical symptoms of anemia include fatigue, depression, concentration problems, loss of appetite, sleep disturbance, shortness of breath and heart palpitations...

End-stage renal disease (ESRD) is a rapidly growing global health problem within the past decades due to increased life expectancy, diabetes mellitus, hypertension, and vascular diseases. Since ESRD is not curable definitively, patients suffering from ESRD have a very low quality of life; therefore, symptomatic management is the cornerstone of medical treatment. Uremia affects almost all body organs, such as skin, through different mechanisms including biochemical, vascular, neurologic, immunologic, hematologic, endocrine, and electrolyte and volume balance disturbances. Some of these conditions are associated with significant morbidity, and patients with ESRD commonly present with a spectrum of dermatologic disorders. Each one has its own unique presentation and treatment approaches. In this review article, we discuss the clinical presentation, pathophysiology, and treatment of the most common skin disorders associated with ESRD.

The presenting pt is a 13 years old girl who developed ESRD due to Bardet - biedl syndrome. She was complaining of sever weakness, lethargy, nausea, vomiting, dyspnea and decreased level of consciousness. Physical examination revealed all sings of this syndrome, which includes polydactyly, pigmented Retinopathy, truncal obesity, mental retardation, underdevelopment of sexual characteristics. In lab, sever anemia, serum creatinin 8mg/d, hyperkalemia and metobolic acidosis revealed. According to above mentioned evidences, and small size kidneys in ultrasonograghy, and also with attention to this point that she is a product of a familial marriage, diagnosis of Bardet - Biedl syndrome is documented.

Introduction: Abnormalities in auditory system are frequent in patients with End-Stage Renal Disease (ESRD). There is not any consensus for the effect of renal failure and hemodialysis on auditory complications. The aim of this study was to evaluate the auditory abnormalities in pediatric ESRD patients undergoing long-term hemodialysis and compare the results with those of nondialytic Chronic Renal Failure (CRF) children and controls.Methods: Children aged 1 to 16 years were evaluated in three groups: 25 ESRD patients undergoinghemodialysis, 25 nondialytic patients with CRF, and 25 age- and sex-matched normal counterparts.Patients with history of otological disease, ear trauma, diabetes mellitus, receiving ototoxic drugs and syndromes with hearing abnormalities were excluded. The Auditory Brain stem Response (ABR) and Otoacostic Emission (OAE) were tested in all subjects. Frequency of cases with abnormal findings was compared between the groups.Results: Seventy two percent of patients were male.The mean age of patients was 9.9 ± 3.2 years. The mean duration of dialysis was 22.2 ± 12.2 months.The ABR testing in dialytic patients showed abnormal results in 11 (44%) patients as bilateral symmetric increased V latency by 35 decibels amplitude in frequencies between 1000 and 4000.The ABR testing was normal in nondialytic CRF children and controls (P<.001). The OAE testing was abnormal in all dialytic patients with abnormal ABR testing results (44%) in 1 (4%) nondialytic CRF children and in no controls (P<.001). There was no significant difference with regard to age, gender, height, weight, blood pressure, serum levels of blood urea nitrogen, creatinine, sodium and potassium, glomerular filtration rate, duration of dialysis, and dialysis adequacy between dialytic patients with and without abnormal results of ABR/OAE testing.Conclusions: Sensorineural hearing loss is rare among nondialytic pediatric patients with CRF but very common in ESRD children undergoing long term hemodialysis.