Seropositivity to hepatitis C virus (HCV) was evaluated in three groups of Saudi children. One group (n = 18) was maintained on haemodialysis and another group (n = 21) on continuous ambulatory peritoneal dialysis (CAPD). The third group were community-based normal controls. The prevalence of antibody to HCV (anti-HCV) in children on haemodialysis (11.2%) was significantly higher than that in the control group (n = 220) (1.4%; p = 0.056). There was no significant difference in the prevalence of anti-HCV between children on CAPD (4.8%) and the control group (1.4%; p = 0.244). Among ten children on haemodialysis who were anti-HCV-negative 4 years earlier, two seroconverted and the seroconversion was not due to transfused blood but was most likely due to environmental contamination. This is the first report on the prevalence of anti-HCV in children maintained on CAPD. The results of the study emphasize the need for separate dialysis machines for anti-HCV-positive patients. It seems that CAPD therapy might reduce transmission of HCV but a large number of CAPD patients will need to be studied to confirm superiority to haemodialysis in this respect.

SUMMARY. The seroprevalence of antibodies against hepatitis E virus (HEV) and hepatitis C virus (HCV) was investigated in Saudi children with sickle cell anaemia (SCA) (50 patients: 28 boys, 22 girls; age range 2–14 years) and P‐thalassemia major (28 patients: 12 boys. 16 girls; age range 2–12 years). The SCA patients were from the Gizan area (South) while the thalassemics were from the Riyadh area (Central province). The prevalence of hepatitis E virus antibody (HEVAb) in patients with SCA (18.0%) and in those with β‐thalassemia major (10.7%) was higher than in the control groups (5.5% and 2.8%) but this did not reach the level of statistical significance. In contrast to the situation with HEV, hepatitis C virus antibody (HCVAb) positivity was significantly higher in patients with SCA (16.0%) and in thalassemics (57.1%) than in the respective control groups. Although the difference in HEV seropositivity between P‐thalassemia major, SCA patients and their respective controls is not statistically significant, the possibility of blood‐borne HEV in the Saudi population cannot be excluded. Further investigations using HEV‐specific polymerase chain reaction techniques are required to confirm whether transmission of HEV through blood preparations or transfusion is possible.

We reviewed 71 cases of children and adolescents with nephrolithiasis over a 9 year period (1982-1991). The mean age was 12.3 years. The male: female ratio was 2.5:1. Twelve patients (16.9%) had bilateral stones. Fifteen patients (21%) had documented urinary tract infection. Escherichia coli was the most common organism growing in the urine cultures. Five patients had metabolic abnormalities and four had genitourinary developmental anomalies. Of the 45 calculi recovered for analysis, 17 (37.8%) were predominantly calcium oxalate, 14 (31.1%) were mixed calcium oxalate and uric acid stones, two (4.4%) were uric acid, two (4.4%) were calcium phosphate, two (4.4%) were cystine and eight (17.8%) were struvite stones. Four patients passed their stones spontaneously. Forty-eight underwent open surgery, with complete stone clearance in 45 patients. Two patients needed nephrectomy, seven had their stones removed by endourological procedures, nine patients were referred to other centers for extra corporeal shock wave lithotripsy, while two did not need any intervention. After the initial hospitalization, 57 patients continued follow up for a mean period of 3.3 years. Of them sixteen patients (28.1%) had recurrence of stone disease. We conclude that renal stone disease in children in our area was not uncommon. The majority were calcium oxalate stones. The clinical manifestations were not specific. Open surgery was needed in the majority of patients. Due to significant recurrence rate, long term follow-up was essential. Follow up by a pediatric nephrologists and/or urologist would be advisable.

Twelve clinical and laboratory characteristics of nephrotic syndrome were compared in 24 children with biopsy-proven mesangial proliferative glomerulonephritis (MesPGN) and 17 children with biopsy-proven minimal-change nephropathy (MCNS). The objective of the study was to determine if these characteristics alone, without renal biopsy, could be used to differentiate the two histopathologic entities. Sex, urinary protein level and IgM immunofluorescence were found to be significantly different in the two groups. Discriminant analysis produced two formulae which gave a discriminant rate of 79% for MesPGN and 76% for MCNS. We conclude that the clinical and laboratory characteristics studied could not differentiate MesPGN from MCNS.

Twenty Saudi children (mean age: 7.7 years) with chronic renal failure who had received several blood transfusions were screened for antibodies to hepatitis C virus (anti-HCV), antibodies to the human immunodeficiency virus (anti-HIV) and antibodies to the various markers of hepatitis B virus (HBV). Prevalence of anti-HCV antibodies was significantly higher in these patients (45%) than in controls (1%) (p less than 0.001). In contrast, the exposure rate to HBV was similar in both groups (15.0% in patients vs 16.8% in controls). These results underscored the high risk of acquiring HCV infection in patients on haemodialysis irrespective of age. Currently, practices such as screening blood for HBsAg and other preventive measures seem to be effective in controlling HBV but not HCV infection in patients on haemodialysis. Perhaps, as with HBV, a stringent policy regarding HCV should be implemented if HCV is to be controlled. None of our patients or controls was anti-HIV positive.

There are few reports about invasive candidiasis in infants in the tropics in general and in the Kingdom of Saudi Arabia in particular. Two Saudi infants with invasive candidiasis are reported and their clinical features and response to treatment are compared with that found in the paediatric literature, mainly from the developed world. Prematurity, low birthweight, invasive procedures, long hospital stay and prolonged use of broad-spectrum antibiotics were found to be predisposing factors in the two patients, and we believe that a lack of awareness of these by the referring physicians led to a delay in diagnosis. The need for greater awareness and vigilance, and the dangers inherent in overlooking isolates of candida from clinical materials are emphasized.

Human brucellosis is a multisystem disease that may notoriously mimic many other illnesses leading to misdiagnosis and increased morbidity. Six pediatric cases of brucellosis who had no epidemiologic evidence of the infection escaped early or correct recognition. The diagnosis of brucellosis was later made on the basis of significant brucella serology and positive blood or bone marrow culture. In endemic areas, a high index of suspicion should prevail in the evaluation of patients with vague or unexplained symptoms.

The clinicopathological features are described in 119 Arab children in Saudi Arabia with the nephrotic syndrome. The clinical and laboratory data are similar to those described in other parts of the world. However, mesangial proliferative glomerulonephritis (MesPGN) was found in 21 of 66 biopsies (31.8%), giving a frequency of 17.6% of all children with the nephrotic syndrome. Minimal-change nephrotic syndrome (MCNS) was diagnosed in 17 biopsies (25.8%) and in 58 patients (48.7%). Onset of the nephrotic syndrome was at less than 1 year of age in 17 patients (14.3%). Seven children had 11 episodes of peritonitis. Seven children had positive hepatitis B surface antigen (HBsAg) in their serum: renal biopsy carried out on four of them showed membranous glomerulonephritis (MGN) in three, and four of the seven patients developed end-stage renal disease (ESRD). There were nine deaths, all in patients with end-stage renal disease: six of the deaths occurred in infants. The pattern of childhood nephrotic syndrome in Saudi Arabia is different from the pattern in tropical countries.