KARACHI Sept 9: In Pakistan, the magnitude of renal problems among children has not been emphasized, despite the fact that an overwhelming number have been victimized by this ailment.

Diseases related to the kidneys are responsible for five to seven per cent of hospital admissions and 20 per cent of out-patients who visit paediatric wards with renal problems.

Dr Afroz Ramzan Sher Ali, a senior paediatric nephrologist at the National Institute of Child Health (NICH), said that it was noted during a recent survey that among renal problems, 12-14 per cent of children were suffering from chronic renal failure.

“Renal stones are the most common cause of both acute and chronic kidney failure and other conditions like congenital vesicoreterol reflux leading to urinary tract infection and renal damage, which is the second commonest cause of chronic renal failure.” Referring to the management of kidney failure among children, she said that it is a challenging and formidable task for both the family and paediatric nephrologists, specially if the patient was victimized by end kidney failure, which may prove fatal for them in case proper care is not administered.

“Conservative management consists of dietary modification, control of hypertension with various medication and salt restriction, treatment of acidosis by oral sodabicarbonate, treatment and prevention of crippling bone changes called renal osteodystherapy by use of calcium carbonate and vitamin D supplementation, and correction of anaemia by either repealed packed cell transfusion or (the) use of inject(ing) erythroprotein alongwith iron supplement.”

“Monitoring of growth and development, coupled with close follow up is an essential component of management of kidney failure children,” she said. Underlining the significance of dialysis therapy, she said that it is employed at a stage when, despite all conservative measures, children become/remain symptomatic, as this is the end stage of kidney failure.

“Dialysis treatment for children with kidney failure is (a) well recognized practice globally, although kidney transplantation is the ideal mode of treatment in children with end stage kidney failure,” she remarked.

Referring to the lack of facilities of dialysis treatment in the country, Dr Afroz said it is available to children residing in major cities only, while those in rural areas and smaller cities have no access to the same, which may be attributed as a major cause of rising child mortality caused by the deadly disease. “Children with renal failure (transient kidney failure) may need short term dialysis, which is carried mainly by inserting catheter in (the) abdominal cavity, doing exchanges of dialysis solution over five to seven days, which is called peritoneal dialysis.”

“Some children may need long term dialysis which is done by a machine through a vascular access over 3-4 hours per session, 2-3 sessions per week (maintenance haemodialysis therapy) in centres where such facilities are available.”

She claimed that the institute has full facility of haemodialysis and peritoneal dialysis mode of treatment free of cost for needy children, as children with kidney failure in Pakistan must not be left untreated.—PPI