Chronic renal failure in children: an epidemiological survey in Lorraine (France) 1975-1990.

A comprehensive investigation in Lorraine from 1975 to 1990 identified 127 children (73 boys, 54 girls) under 16 years with chronic renal failure (CRF). From 1975-1980 to 1985-1990 the mean annual incidence of pre-terminal CRF decreased from 12.7 to 7.5 per million children under 16 years of age. The incidence of end-stage renal disease (ESRD) in children increased from 5.6 to 7.5 per million with a peak of 9.1. The prevalence of preterminal CRF was variable (29.4-54) and the prevalence of ESRD increased from 15.5 to 37.0 per million children. Acquired nephropathies were observed in 30.7% and congenital nephropathies in 68.5%. Although patients with acquired nephropathies had only slightly higher serum creatinine levels, they progressed more rapidly to ESRD than those with congenital disease: mean 1.8 years versus 3.85 years after diagnosis of pre-terminal of CRF (P < 0.02). Ten years after onset of pre-terminal CRF, 94% with acquired and 69% of those with congenital nephropathies had started renal replacement therapy (P < 0.001). It is unclear whether the decrease in preterminal CRF reflects a reduced number of children with kidney disease reaching CRF or is the result of a real delay in the progression due to better therapeutic management.