The Hindu : Kerala / Thiruvananthapuram News : Renal diseases in children remain underdiagnosed

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Saturday, Apr 19, 2008
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Kerala

Kerala - Thiruvananthapuram

Renal diseases in children remain underdiagnosed

C. Maya

Increase in cases of kidney stone diseases

Need to implement school-based screening programmes
Lack of paediatric nephrology clinics

THIRUVANANTHAPURAM: Cases of urinary infection in children should be thoroughly investigated, as many of them are later diagnosed as serious renal problems, including kidney stones or urinary reflux diseases.

The Paediatric Nephrology Department at SAT Hospital has reported an increase in cases of kidney stone diseases in children as young as five years old, especially from areas in the district bordering Tamil Nadu.

“We do not know whether this is due to dietary factors or the high oxalate content in soil or water. We also need to implement school-based screening programmes to pick up and treat renal diseases early,” says Susan Uthup, paediatric nephrologist in charge of the department at SAT Hospital.

Special attention should be given to cases of urinary infection in children below two years. Repeated episodes of urinary infections can lead to secondary hypertension in children and hence checking their blood pressure is important.

But cases of urinary infections are treated in a routine manner in the periphery.

The department, which studied the prevalence of hypertension in schoolchildren in select rural and urban areas in the district, reported that the prevalence rate was about 4 per 1,000 children.

Renal diseases in children, including congenital defects, are thus underdiagnosed and due to lack of awareness among the public, poorly managed, Dr. Uthup says. She says she sees a lot many cases of congenital renal problems such as hydro nephrosis or nephritic syndrome, which are often detected through ante-natal scans at SAT Hospital.

Many of these are treatable conditions.

However, parents often tend to neglect the underlying disease once the initial symptoms subside. Thus a good number of children go on to develop chronic renal problems by the age of 10 or 11, which necessitates either maintenance dialysis or renal transplant.

While there is a genuine need to pick up and treat the growing load of renal problems in children in the community, the sole Paediatric Nephrology clinic in the public sector at SAT Hospital has been struggling to manage its case load due to space constraints as well as staff shortage.

Staff shortage

The twice-weekly clinic is run by a single doctor in charge of the department and even the services of postgraduate students are not available on a regular basis.

The clinic, which sees at least 35 to 40 new cases of children with renal problems every month, is unable to provide the long-term quality care that each case needs.

“Renal diseases are chronic, slow-progressing and never picked up early enough for a satisfactory treatment outcome.

“Ideally, we need a community-based early screening programme, which should be backed by a comprehensive and long-term renal management programme at the hospital-level, because treatment is expensive,” points out Dr. Uthup.

There are not many hospitals in the private sector too, which offer the sub-speciality of paediatric nephrology. The clinic started functioning on a full-fledged basis in August last year with the acquisition of a haemo dialysis unit.

The unit performs two and often stretches it to three dialysis a day, with a single technician to run the machine.

Despite its infrastructural and human resources limitations, so far, the department has done about 700 haemo dialysis, some 100 renal biopsies and one renal transplant too.

The department is expected to get another haemo dialysis unit under the Rs.120-crore development project of Medical College Hospital.

It has now forwarded a proposal to the Health Department to give it more doctors, staff nurses and technicians.

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