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Times of India
14 March 2011
By Umesh Isalkar
Pune, India

Slowly rogressive, chronic diseases of the kidneys, which often go unnoticed in children until the kidneys have been severely affected, are worrying, since some of them progress to an end–stage renal disease (ESRD), say experts.

"Early clues to kidney diseases in children are unexplained fevers, and in boys its difficulty in passing urine or passing too much or too little urine, underclothes continuously wet with urine, progressive swelling around the eyes on waking up and not gaining height," says Jyoti Sharma, paediatric nephrologist with the Bharati Hospital.

The exact prevalence of kidney diseases in Indian children is not known. However, the Indian Society of Paediatric Nephrology, in collaboration with the Indian Society of Nephrology, has initiated a chronic kidney disease (CKD) registry in an effort to collect and record information regarding children with CKD. The objectives are to acquire and collate information about CKD in Indian children and advocacy for improving their management.

"From the preliminary information available, it is clear that a large number of children, who progress to ESRD, had birth defects such as abnormally formed kidneys and urinary tracts with blockages at various levels, resulting in infections and back–pressure that damage the kidney," Sharma says. To continue living, these children would eventually need dialysis or kidney transplantation. Both these modalities are expensive and often out of reach of the common man. However, in many of these children, early diagnosis is useful since, with appropriate management, progression of some of them can be halted or slowed, he adds.

Elaborating, Sharma says, "Ultrasonography of pregnant women done by an expert may identify some of these abnormalities and alert the managing doctor about the need for close follow–up of the baby after birth."

Sharing the view, paediatrician Sanjay Lalwani says, "Some kidney diseases run in families so it is important for parents to discuss this with the child's paediatrician. It is now recommended that once a year blood pressure of all children more than 3 years of age with an appropriate sized cuff should be recorded."

Chronic illness of any kind in children is very difficult for parents to accept, and more so for grandparents, who are often active participants in the care of our children. The greatest challenge a paediatric nephrologist faces is that of explaining that the child has a chronic disease, especially, since kidney disease may be silent and the child appears active, healthy and growing well in the early stages, Lalwani said.

The most common response is of disbelief or denial: "We have never heard of children having kidney disease." Parents often do not comply with the recommended investigations until the disease has progressed considerably, and no longer amenable to management.

Parents may get a second, third or fourth opinion, or parents may refuse to return to the doctor thinking, "If we don't think about it, the problem will go away." Others decide to try herbs and diet modifications and thus lose precious time during which treatment could have been initiated," Sharma says. The world observed World Kidney Day recently on March 10.

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