Dechen Tshomo 

Renal diseases have become a major cause of morbidity and mortality among hospitalised children in the country.

About 28 children with renal diseases admitted to the national referral hospital in Thimphu in 2018 succumbed to the disease, according to a study conducted by a pediatric resident of the Department of Paediatrics, Faculty of Post Graduate Medicine.

This means at least one child aged one month to less than 13 years died every month because of renal diseases. Of the 1,648 children admitted to the hospital in 2018, 128 had renal diseases or diseases related to kidney.

The pediatric resident, Dr Sonam said renal diseases refer to any disease or disorder associated with renal systems in children.

The study carried out to determine the burden of renal diseases among children with renal diseases admitted in JDWNRH from January to December 2018 found that the situation is similar to those reported in other developing countries.

As per the literature review, he said renal diseases among hospitalised children ranges between 1.3 to 8.9 per cent. In his study, it was found that 128 children, that is 7.8 per cent of the total children admitted in the hospital had renal diseases. “This was comparable to studies from other countries.”

The study found that acute kidney injury (AKI) was the most common renal disease associated with morbidity and mortality of those admitted children with renal diseases.

He said AKI is an impairment of renal functions. It is diagnosed when there is either a reduction in urine output or increase of creatinine.

About 48 children were reported to have AKI, followed by acute glomerulonephritis and urinary tract infection with 28.9 per cent or 37 cases each. Congenital abnormality of kidney and urinary tract and nephrotic syndrome constituted 8.6 per cent each.

Of the total deaths, 26 had AKI and two had chronic kidney diseases. The median duration of hospital stay was eight days.

About 40 patients of the total admitted were referred to Paediatric Intensive Care Unit (PICU) with a median duration of ICU stay of 6.5 days. Four were referred abroad for further treatment and another five underwent dialysis.

Health officials said children with renal diseases present with non-specific signs and symptoms due to which it often went undetected.

The study recommends improving pediatric renal services which would help in early detection and treatment of such conditions.

He said AKI of infective etiology the most common renal disease associated with morbidity and mortality in the study, is mostly preventable.

“This could be reduced or prevented through education and creating awareness among parents about pediatric renal diseases like it is currently being done for adult chronic kidney diseases, and timely follow up before complications develop.”

The department is currently run by general paediatricians. “We don’t have pediatric subspecialists in the field of nephrology unlike in adult medicine”

While the department has started providing peritoneal dialysis services to the children with AKI since 2018, the department still faces challenges when the older children require hemodialysis as it lacks expertise in pediatric hemodialysis.

He said some complicated cases require certain tests for which the samples are sent to India since it is unavailable in the country and some require referral abroad for renal biopsy and pediatric nephrology consultation.