Background This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. Methods This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. Results The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). Conclusions This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information .

Background Continuous kidney replacement therapy (CKRT) is utilized in the management of acute kidney injury (AKI). For infants and newborns, it is a challenging procedure. This study aimed to determine the outcomes of CKRT among infants and newborns, given the limited literature available. Methods A retrospective study reviewed charts and the Virtual Performance System in pediatric intensive care unit (PICU) in a tertiary care center in Saudi Arabia. This study included 40 patients (aged 0–1 year) who underwent CKRT from September 2009 to December 2019. Exclusion comprised individuals with a CKRT duration of <24 hours and patients whose primary diagnosis was cardiac in origin. Demographics, nature of diseases, presence of multiorgan failure, modality, and prescriptions of the CKRT were reported. Statistical analysis identified the correlation between the outcome and the mentioned data. Results The median age at intensive care unit (ICU) admission (0–12) was 5 months, and the median weight (2.20–9.70) was 5.45 kg. The most common category was bone marrow transplantation (42.5%), followed by metabolic conditions (20%). The most common modality was continuous venovenous hemodialysis ( n = 21; 56.8%). The median blood flow rate (20–100) was 50 mL/min, and the median dialysate flow rate (100–800) was 400 mL/h. The median duration of PICU stay (0.80–139.01) was 16.97 days. Twelve patients (30%) survived, while the majority, 28 (70%), did not survive. The median duration of CKRT was 38.95 h. Most of the patients, 37 out of 40 (92.5%), developed complications during CKRT, with hypothermia (62.5%). The nonsurvived group had a higher weight (6 vs. 4.3 kg, P < 0.01) and was older at ICU admission (6 vs. 3.33 months, P = 0.02). The primary diagnostic category, reason to initiate CKRT, and the presence of multiorgan failure were found to be significantly correlated with the outcome ( P < 0.01). Additionally, a significant correlation was found between serum creatinine levels after 3 months of CKRT and age at ICU admission (correlation coefficient 0.47, P = 0.05). Fifty percent of the patients had an overall survival time, from initiating CKRT until the PICU patients’ physical discharge, of 13 days (95% confidence interval: 9–26). Conclusion The overall mortality rate for all causes of CKRT initiation was 70%. However, newborns and infants who underwent CKRT for metabolic causes exhibited an 88% survival rate. Additionally, weight, age at ICU admission, coagulopathies, and the presence of multiorgan failure showed a significant a correlation with the outcome.

Background: Organ transplantation is inherently dependent on the availability of organ donors. There is a noticeable paucity of literature addressing the rates of organ donation registration and the awareness of Islamic regulations (Fatwa) regarding organ donation within Saudi Arabia. Our study aimed to evaluate the level of organ donation registration, awareness of Islamic regulations, and knowledge of the Saudi Center for Organ Transplantation (SCOT) within the Saudi society. Methods: We conducted a cross-sectional survey from 30 March to 9 April 2023. This survey aimed to assess the awareness of Islamic (Fatwa) guidance on organ donation, the role of SCOT, and the rate of organ donation registration facilitated through the Tawakkalna app, the official health passport application in Saudi Arabia. Results: Out of 2329 respondents, 21% had registered as potential deceased organ donors, despite 87% acknowledging the importance of organ donation. Awareness of the Islamic Fatwa regarding organ donation was reported by 54.7% of respondents, and 37% recognized the Fatwa’s acceptance of brain death criteria. The likelihood of registration as organ donors was higher among Saudi citizens under 45 years of age, females, healthcare workers (HCWs), individuals with higher education, relatives of patients awaiting organ donations, those informed about the Islamic Fatwas, and those willing to donate organs to friends. Conversely, being over the age of 25, Saudi nationality, employment as an HCW, awareness of SCOT, and prior organ donation registration were predictive of a heightened awareness of Islamic Fatwas. However, perceiving the importance of organ donation correlated with a lower awareness of the Fatwas. Significant positive correlations were found between awareness of SCOT, awareness of Fatwas, and registration for organ donation. Conclusions: While the Saudi population exhibits a high regard for the importance of organ donation, this recognition is not adequately translated into registration rates. The discrepancy may be attributable to limited awareness of SCOT and the relevant Islamic Fatwas. It is imperative to initiate organ donation awareness campaigns that focus on religious authorization to boost organ donation rates and rectify prevalent misconceptions.

Background: Nephrotic syndrome is the most common kidney disease in children worldwide. Our aim was to critically appraise the quality of recent Clinical Practice Guidelines (CPGs) for idiopathic steroid-sensitive nephrotic syndrome (SSNS) in children in addition to summarize and compare their recommendations. Methods: Systematic review of CPGs. We identified clinical questions and eligibility criteria and searched and screened for CPGs using bibliographic and CPG databases. Each included CPG was assessed by four independent appraisers using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE-II) instrument. We summarized recommendations in a comparison matrix. Results: Our search retrieved 282 citations, of which three CPGs were eligible and appraised: Kidney Disease: Improving Global Outcomes (KDIGO) 2012, Japan Society for Pediatric Nephrology (JSPN) 2014, and American Academy of Pediatrics (AAP) 2009. Among these, the overall assessment of two evidence-based CPGs scored > 70% (KDIGO and JSPN), which was consistent with their higher scores in the six domains of the AGREE II Instrument. In domain 3 (rigor of development), KDIGO, JSPN, and AAP scored 84%, 74%, and 41%, respectively. In domain 5 (applicability), they scored 22%, 16%, and 19%, respectively, and in domain 6 (editorial independence), they scored 94%, 65%, and 88%, respectively. Conclusions: The methodological quality of the KDIGO CPG was superior, followed by JSPN and AAP CPGs with the relevant recommendations for use in practice. Systematic review registration: The protocol was registered in the Center for Open Science (OSF) DOI: 10.17605/OSF.IO/6QTMD.

We report a newborn baby girl with a rare cause of hyperammonemia, in which a session of continuous renal replacement therapy (CRRT) was performed successfully despite the child's small size. The baby was born at 34 weeks' gestation with a birth weight of 2.2 kg and was referred on day 4 of life with lethargy, bradycardia, hypothermia, hypoglycemia, and metabolic acidosis associated with hyperammonemia. Following the insertion of the GamCath line, CRRT was performed using continuous venovenous hemodialysis modality, Ultraflux AV Paed dialyzer (Fresenius Medical Care), and multiFiltrate pediatric kit. Over 19 h of therapy, serum ammonia level reduced from >700 μmol/L to 103 μmol/L. Next-generation sequencing revealed a homozygous pathogenic variation in SLC25A20 (NM_000387; exon2; c.109C>T; p.R37X), leading to a diagnosis of carnitine-acylcarnitine translocase deficiency. The child succumbed during a subsequent hospital stay. This case instructively informs on the feasibility and efficacy of CRRT in the management of neonatal hyperammonemia.

Urinary ascites is a rare condition characterized by abdominal distention and renal impairment on biochemical investigation. Most often it occurs secondary to trauma, abdominal surgery, or after chemotherapy. In the neonate, it can occur either spontaneously or secondary to a urogenital malformation or umbilical catheterization. We describe a unique case of spontaneous urinary bladder perforation presenting with urinary ascites and an acute kidney injury picture in early childhood without underlying urogenital anomaly or trauma.