تلخیص
Pakistan is the 6th populous country in the world
and is 36th largest nation by total area. Pakistan’s
overall health issues are protean and comprise of
a dual burden of communicable and noncommunicable (NCD) diseases, large child
population, high maternal and Under-5 mortality
rate with widespread malnutrition in children and
worst provisions in terms of health services. It is
one of the two countries in the world where polio
is still endemic. Major causes of high neonatal,
infant and Under-5 mortality rates include
asphyxia, low birth weight, neonatal sepsis,
malnutrition, pneumonia, diarrhea and other
vaccine preventable diseases. NCDs, including
kidney diseases now are gaining importance as
cause of mortality and morbidity in children.
However in the wake of more pressing public
health issues, kidney diseases along with other
chronic childhood problems have been
relegated as problems of secondary importance
in a country like Pakistan.
Data on the prevalence and incidence of kidney
disease in children is difficult to obtain in Pakistan
and only a glimpse of tantalizing fragments of
epidemiology can be appreciated in the form of
hospital data. Pakistan is a heterogeneous
country with different socio-economic and
geographical factors which play important roles
in prevalence and pattern of renal disease in
Pakistan1. Pediatric Nephrology is a relatively new
specialty in this country with very few well
established centers and there is lack of proper
national registry for pediatric renal patients,
hence available data is scanty and is based on
statistics of tertiary care hospitals. There are two
types of kidney disease in children, acute and
chronic. Acute diseases appear suddenly but are
generally short-lived, reversible if treated
promptly and adequately. Acute Kidney Injury
(AKI) is a common and serious problem in
children and its overall incidence is high in
hospitalized children (5%) and even higher in
preterm babies, neonates with asphyxia and in
intensive care settings (as high as 30-50%). Acute
diarrhea, dysentery, streptococcal infections of
throat and skin, malaria and other infections
associated with rampant malnutrition are directly
and indirectly causative factors of AKI. In contrast
to developed world, where there has been shift in
etiology from primary renal disease to more of
secondary causes occurring as an aftermath of
use of advanced technology such as surgery for
congenital heart disease, transplants and care of
sick children. Introduction of RIFLE criteria2 by
Acute Dialysis Quality Initiative Group (ADQI) and
classification of AKI by Acute Kidney Injury
Network (AKIN) has widened the spectrum of AKI
and minor deteriorations in GFR can be detected
early and intervened appropriately with the result
that more and more cases of AKI are being
recognized. Infections of urinary tract are one of
the most common infections in pediatric
population and may lead to significant acute
morbidity and irreversible renal damage and
affect at least 3% of boys and 11% of girls.
Diagnosis of urinary tract infection (UTI) in young
children is important as a marker for urinary tract
abnormalities3. Injudicious use of antibiotics in
Pakistan result into missing of these infections and
ultimate delay in diagnosis and inadequate
management may lead to complications like
vesicoureteric reflux, renal scarring and chronic
kidney disease
Tahir Masood Ahmed. (2016) Pediatric Kidney Disease in Pakistan, Pakistan Pediatric Journal, Volume 40, Issue 1.
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