ABSTRACT
Though renal transplant is preferred mode of renal replacement therapy [RRT], peritoneal dialysis [PD] is an important modality of treatment for children with end stage renal disease [ESRD] but it is underutilized in Pakistan despite several advantages over haemodialysis [HD]. The burden of paediatric chronic kidney disease [CKD] and ESRD is under reported, since majority of children [24-63%] present with acute on chronic kidney disease often complicated by multiple co-morbid conditions which may result in death before consideration of long term RRT. In Pakistan, the available care of ESRD/CKD is exclusively hospital based rather than home based dialysis. Manual PD is used as first line option of treatment for acute kidney injury [AKI] or acute on CKD at few centers and long term maintenance PD is not offered at all as first line option of treatment for children with ESRD. Generally, long term PD is less expensive than HD or at least as expensive as HD. This holds true even for most of the developed countries using automated cycler machines but scenario in developing countries like Pakistan is quite different. HD is the only option offered to older children for short period and very few of them become successful to get a renal transplant. Home dialysis or Continuous Ambulatory PD [CAPD] may be the only option to treat young infants to make them free of complications of uraemia and provide adequate nutrition for growth till either HD or transplant become possible
This may be possible once paediatric and adult nephrologists as well as pediatricians recommend and advocate this option for survival of children with ESRD. Furthermore, we need to strengthen the existing RTT facilities and develop more paediatric peritoneal dialysis centers; local production of dialysis fluid and disposables or government should allow free import of PD equipments and solutions
This will not be possible without efforts of all of us including professionals, dialysis nurses or technicians, media persons, pharma industry and community workers as well as parents
ABSTRACT
To determine the histopathological pattern in childhood glomerulonephritis [CGN]. This retrospective analysis of renal biopsies of 118 children with various clinical syndromes of CGN was carried out at the National Institute of Child Health [NICH] and The Kidney Center [TKC], Karachi, from July 2005 to December 2009. The age ranged from 6 months to 16 years. All biopsies were studied under light microscopy [LM] and immunoflourescence [IMF] Histopathological lesions [HPL] were classified as primary and secondary glomerular diseases. Demographic data, indications and HPL were retrieved and analyzed using descriptive statistics. Out of 118 patients, 62 [52.54%] were males and 56[47.45%] females. Mean age was 8.2 +/- 3.9 years. Major indications for biopsy were primary nephrotic syndrome [PNS 86, 72.88%]. secondary GN [SGN, 17, 14.4%] and nephritic-nephrotic syndrome [NNS 13, 11%]. Overall, primary glomerular diseases [PGD] accounted for 84.74% of all biopsies. Minimal change disease [MCD 38, 32.2%] and focal segmental glomerulosclerosis [FSGS 35, 29.66%] were the two most common lesions and accounted for 43% and 33.72% respectively in PNS. Other important lesions were membranous GN [MGN 10, 8.47%], membranoproliferative [MPGN 9, 7.16%], post-infective [PIGN 4, 3.38%] and IgM nephropathy [IgMN 3, 2.54%]. Among secondary glomerular diseases [SGD], lupus nephritis [LN 11, 9.32%] was the most common lesion followed by Henoch-Schonlein nephritis [HSN] and haemolytic uraemic syndrome [HUS] each in 3 [2.52%]. Overall, MCD and FSGS were the two most common HPL in PGD and both dominated in PNS. Lupus nephritis was the leading lesion in SGD. These histopathological pattern of CGN in our study is in conformity with the existing literature from Pakistan