{{Medical experts have alerted to the rising cases of chronic kidney disease in the nation’s children, which they blame on infections, diarrhoea, malaria, hepatitis, Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).}}
They called for screening programmes, manpower training and improvement of diagnostic and therapeutic facilities to address the situation.
In a recent study which has been accepted for publication by the Saudi Journal of Kidney Disease, the paediatricians from the Department of Paediatrics, Lagos University Teaching Hospital (LUTH), Idi-Araba, led by Prof. Afolabi Lesi and Dr. Taiwo Ladapo, noted that of all the children admitted over a four-year period (2008 to 2011) in LUTH, kidney disease accounted for 8.9 per cent of paediatric admissions with prevalence of 22.3 admissions per 1,000 child-admissions per year; and that yearly incidence doubled over the study period.
The study is titled “Paediatric kidney diseases in an African country: Prevalence, Spectrum and Outcome.”
The researchers noted that nephrotic syndrome, acute kidney injury (AKI) and nephroblastoma accounted for almost 70 per cent of admissions; and that the overall mortality rate was 12.6 per cent with AKI being the leading cause.
They observed that the prevalence of AKI was higher than that reported from other parts of the country; late presentation, inadequate diagnostic and therapeutic facilities and financial constraint negatively impacted outcome; and disease-specific prevalence varied between geographic sections.
Nephrotic syndrome is caused by different disorders that damage the kidneys. This damage leads to the release of too much protein in the urine.
Nephroblastoma or Wilms’ tumor is cancer of the kidneys that typically occurs in children, rarely in adults.
The researchers in an earlier study published in the December 2012 edition of the journal PLOS ONE concluded: “Acute kidney injury is common in children admitted to hospitals. The common causes remain primary kidney diseases, sepsis and malaria but the contribution of sepsis is rising while malaria and gastroenteritis are declining. Acute kidney injury-related mortality remains high.”
The results of the study titled “Paediatric Acute Kidney Injury in a Tertiary Hospital in Nigeria: Prevalence, Causes and Mortality Rate” showed that of the 4,015 children admitted into LUTH between July 2010 and July 2012, 70 episodes of AKI were recorded, equalling 17.4 cases per 1,000 children.
The researchers found, among other things, that: the median age of the children with AKI was 4.8 (range 0.1–14.4) years and 68.6 per cent were males. Acute kidney injury was present in 58 (82.9 per cent) children at admission with 70 per cent in ‘failure’ category; primary kidney disease (38.6 per cent), sepsis (25.7 per cent) and malaria (11.4 per cent) were the commonest causes; the primary kidney diseases were acute glomerulonephritis (11) and nephrotic syndrome (eight); 19 (28.4 per cent) children with AKI died; need for dialysis was associated with death.
Glomerulonephritis may be caused by problems with the body’s immune system. Often, the exact cause of glomerulonephritis is unknown. Damage to the glomeruli causes blood and protein to be lost in the urine. The condition may develop quickly, and kidney function is lost within weeks or months (called rapidly progressive glomerulonephritis).
Glomeruli (glomerulus is singular) are tiny tufts of capillaries, which carry and filter blood within the kidneys. A quarter of people with chronic glomerulonephritis have no history of kidney disease.
Ladapo in an exclusive interview with The Guardian said the first dialysis section for children with chronic kidney disease costs about N40,000 to N50,000 for one and subsequently the child should have it three times a week at the cost of about N20,000 per session.
Another study published in the January 2013 edition of the Saudi Journal of Kidney Disease and Transplantation concluded that the prevalence of renal disease in Highly Active Anti-Retroviral Therapy (HAART)-treated Nigerian children is high and the majority of those with the disease, although asymptomatic, were at the advanced stages of HIV infection.
The researchers from the Department of Child Health, University of Benin, Benin City, Edo State, wrote: “It is therefore important that early detection of renal damage, in the asymptomatic stage, is made in order to institute measures early, which may reverse or slow down the progression of kidney disease to End Stage Renal Disease (ESRD). This may be the most significant preventive strategy, especially as facilities for renal replacement care are limited and expensive in resource-poor countries.”
According to the President-elect, Nigerian Association of Nephrology and Chief Medical Director at St. Nicholas Hospital, Lagos, Dr. Ebun Bamgboye, 36.8 million Nigerians (23 per cent) are suffering from various stages of kidney disease.
With this figure, it means that one in seven Nigerians is suffering from some form of kidney disorder.
Bamgboye, who disclosed this at an awareness programme organised by the hospital to mark this year’s World Kidney Day in March 2013, regretted that despite the severity of the disease, Nigerian patients are faced with many challenges in terms of treatment.
Bamgboye lamented the burden of the disease, noting that an estimated 15,000 new patients are diagnosed every year in the country.
He said: “Chronic kidney disease prevalence is a problem in our environment. Estimates suggest that one out of every seven Nigerians has one stage of chronic kidney disease. Unfortunately, out of 50,000 patients who should ideally be on dialysis, less than 1,000 are currently on dialysis as at today.
“Unfortunately, if you have kidney failure and you don’t do dialysis or transplant within two weeks, you will die. You can imagine the number of people that are dying every day because of kidney disease.”
Reacting to questions from The Guardian, Ladapo who is the joint leader of the team of researchers from LUTH said: “Kidney disease unlike what most people believe are real in children. Many people wonder whether kidney disease is also found in children? Does it affect children? Very much so. I am coming down from the ward now. I am late for this interview because of a child with kidney disease. We are beginning to see kidney disease more in children.
“There is a paper I will send to you, which has been accepted for publication by the Saudi Journal of Kidney Disease this year. Kidney diseases are on the increase in children. Unfortunately, one of the conditions most expensive to treat are kidney diseases and there is nowhere in the world, very few countries in the world do people pay out of pocket. I cannot afford it. You have a lot of government support for children on dialysis, you have a lot of private sector support.
“One of the things we are trying to do is to raise awareness about the increase in kidney disease in children and also raise support for children who need dialysis. When I leave here now, I am going to start dialysis in a child. There is another child that started dialysis last week. This child has chronic kidney disease. The first dialysis section costs about N40,000 to N50,000 for one and subsequently this child should have it three times a week at the cost of about N20,000 per session and the mother is a trader and you know they are indigent.”
On why more children are turning up with chronic kidney diseases, he said: “The reasons are many. Some children are born with abnormality of the kidney tract that is not detected on time and it affects the kidneys. For some, it is not known. Some infectious diseases affect kidney functions in children such as hepatitis. Also, other conditions like nephrotic syndrome, which if not well treated, can cause kidney disease.
“You also have acute kidney injury that is acute renal failure, children coming down with malaria, infection, different kinds of infection such as bacteria infection, pneumococcal infection. Then you have diarrhoea, they come in, they have diarrhoea and have been passing stool and the body fluid is not being replaced, the kidney shuts down.
“If the kidney is not getting enough fluid, it shuts down. Infections also affect the kidney. We are really trying to raise awareness and raise help for children with kidney disease. We have increased our dialysis services. The hospital has been very supportive and now we have two nephrologists on ground and we are trying to boost our services.”
On adults having kidney diseases, he said: “One of the reasons why we are beginning to cry out is that there have been studies done in the developed world and they have found out that some of these diseases actually start in childhood but they are misdiagnosed. So, by the time they are young adults, they are already in chronic or end stage meanwhile the problem started long ago.
“What is being done in developed world for example is that they do school screening. Simple checking of the urine of school children for protein can help detect some children with kidney disease. In developed world, there are screening programmes that pick up these diseases early.
“We don’t have such in Nigeria; nobody is screening anybody for anything. Nigeria is a country that has infectious disease as a main issue. So, you have infections that may affect the kidney then hypertension, diabetes are on the increase. But some have been shown to actually start from childhood.”
On the statistics of children diagnosed with kidney disease at LUTH, he said: “The statistics vary widely even in Nigeria because the criteria used in different studies are not the same. It is difficult to do a synopsis of the studies. Some people look at only children that were seen at the emergency room, some look at those on admission, some look at everybody. So, it is difficult to say.
For example, in a study we just published here, we found out that 8.9 per cent of children on admissions over a five-year period was due to kidney disease.”
NgrGuadian
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