Do you know in our country with a population of more than 1 billion, children contribute 40 % of this population? Adult hospital-based study have shown the prevalence of 0.8 % of exclusive chronic kidney diseases but no recent pediatric data is available for the burden of this disease.

Recognize the hidden illness – Kidney Transplant Treatment in India

Case 1

A 15 yr old boy from a poor family presented in an emergency with seizures. He also had pallor and his blood pressure was 150/100 mmHg (Above the 95th centile). Past history of recurrent urinary tract infections was present. USG showed an absent left kidney and right side small kidney. His kidney function tests were also deranged (Urea/Creatinine: 198/5). The family has explained the diagnosis of chronic kidney disease and the need for dialysis.

Case2

A 3-month-old infant was admitted with poor intake and vomiting off and on for 4 days and not passing urine for 1 day. He was antenately diagnosed with bilateral hydro-uretero-nephrosis and post-natal USG also showed similar findings. His kidney function tests were within the normal limit at birth and discharged without further investigations. Now at admission, he was noted to have fast breathing and irritability. Investigations suggested impaired urea and creatinine (180/ 2.5) and metabolic acidosis. USG showed similar findings. MCU suggested a posterior urethral valve. The child was taken for surgery after stabilizing the KFT. He needed dialysis for the same.

Facts:

Do not ignore the underlying cause, especially with recurrent urinary tract infections as CAKUT is the cause of 30% of all CKD in children. All renal and urinary tract malformations altogether present in 1:500 live-born fetuses, 1:2000 births neonatal death and contribute to 15 % of all prenatally detected anomalies. Other than gene mutation and obstruction, exposure to certain intrauterine factors like a low protein diet, vitamin A deficiency, high/low sodium diet, RAS blockers, etc affect the normal anatomy.

Your Child may need a follow-up with a Pediatric nephrologist (age group: 0-18 years) for:

• Hypertension
• Proteinuria
• Hematuria
• Recurrent urinary tract infection, daytime & night time enuresis, urgency, frequency
• Decline in GFR
• Emergency Dialysis

Imaging needed for complete evaluation if diagnosed early:

• USG
• Voiding cystourethrography
• DTPA
• DMSA

If diagnosed late with chronic kidney disease, neither of the nuclear imaging modalities are required.

Are there any treatment options?

If approached early:

• Timely correction of the underlying cause
• Medicinal management for persistent hypertension, proteinuria

If approach late:

• Dialysis: Hemodialysis, Peritoneal dialysis
• Renal transplant

Early Prevention can help the doctor in preparing a preventive plan.