| Abstract|| |
The pattern of kidney diseases varies in different places due to differences in genetic status, socioeconomic status, access to health care, and presence of background infection. In spite of nephrology as a specialty since 1970s, there are still limited data regarding the spectrum of renal diseases in India. Our study was conducted in a tertiary care institute and referral center in northeast India. It provides insight into profile of renal diseases in hospitalized children. It is a cross-sectional study conducted in a government medical college in Assam. All children who were admitted in this department during one year period were examined for the presence of renal disease on the basis of history, clinical examination, and laboratory investigation. Of total admission, 7.17% of children had renal diseases. Nephrotic syndrome was the most common renal disease followed by glomerulonephritis in this study. Acute post infectious glomerulonephritis was the most common cause of glomerulonephritis. Septicemia was the most common cause of AKI. We have seen that a huge burden of pediatric morbidity is due to renal diseases. Majority of the renal diseases are curable with proper and adequate treatment. A large pool of renal diseases are still due to infective etiology and thus preventable.
|How to cite this article:|
Sonowal R. Profile of renal diseases in North-East Indian children. Saudi J Kidney Dis Transpl 2019;30:1151-5
| Introduction|| |
Pediatric renal disease form about 4.5%–8.7% of total pediatric admission.,, The pattern of kidney diseases varies in different places due to differences in genetic status, socioeconomic status, access to health care, and the presence of background infection., Renal disease in hospitalized children and young adults can be difficult to diagnose early as it may present only with few symptoms. In spite of nephrology as a specialty since 1970s, there is still paucity of data regarding the spectrum of renal diseases in India. Available literature from few hospitals shows data on specific renal diseases only rather than the overall spectrum.
The study was conducted in Gauhati Medical College and Hospital, Guwahati, Assam, India a tertiary care institute and referral center in northeast India. It provides insight of profile of renal diseases in hospitalized children.
| Subjects and Methods|| |
All children who were admitted in the department of pediatrics over one year period, from August 2010 to July 2011 were examined for the presence of renal disease on the basis of history, clinical examination, and laboratory investigation. The initial investigation carried out included complete blood count, erythrocyte sedimentation rate, urine analysis, urine culture and sensitivity, serum electrolytes, blood urea, and serum creatinine. Further investigation carried out as needed included serum cholesterol and protein, chest X-ray, Mantoux test, antistreptolysin O (ASO) titer, 24-h urinary protein estimation, collagen profile, complement level, renal ultrasonography, intravenous urogram, micturating cystourethrography, hepatitis B surface antigen, HIV enzyme-linked immunosorbent assay, and renal biopsy. The diagnosis of nephrotic syndrome, post streptococcal glomerulonephritis, hemolytic uremic syndrome (HUS), acute renal failure, lupus nephritis, congenital renal disease, urinary tract infections (UTIs), and renal tubular acidosis (RTA) were made on clinical and laboratory criteria. Patients were followed up for variable periods of time in outpatient service.
| Results|| |
A total number of 3808 children were admitted during the study period of which 273 (7.17%) children had renal disease. As depicted in [Table 1] among 273 renal cases, 157 had nephrotic syndrome (57.51%). Admission due to glomerulonephritis (GN) was 73 (26.74%). Number of UTI cases were 24 (8.8%);. Acute kidney injury (AKI) cases were 14 (5.13%). Admission due to congenital defect (Cong Def) was three (1.1%). Admission due to RTA and renal calculi, each was one (0.36%). Hence, nephrotic syndrome was the most common renal disease followed by glomerulonephritis during that period. Most common cause of admission due to nephrotic syndrome was the first attack (62.4%) followed by infrequent relapse (34.4%). Frequent relapse was least common (3.2%). Most of the cases of nephrotic syndrome (98.1%) were minimal change nephrotic syndrome (MCNS) (from steroid responsiveness). Only three cases (1.9%) had steroid resistance. Biopsy was done in the three cases and was found to have focal segmental glomerulosclerosis (FSGS).
Acute postinfectious glomerulonephritis (PIGN) was the most common cause of hospital admission due to glomerulonephritis (82.2% of glomerulonephritis cases, 22% of total cases), as shown in [Table 2]. Most of the cases of APIGN had history of sore throat or skin infection. Majority had elevated ASO titer and decreased C3 levels. This is followed by lupus nephritis (LN) and Henoch-Schönlein purpura nephritis (HSP nephritis). Renal biopsy was done in two out of five cases of LN.
As shown in [Table 3], septicemia was the most common cause of AKI (35.7%), followed by malaria (28.6%), APIGN and HUS was cause of AKI in 14.3% of cases each and obstruction due to calculi was the cause of AKI in 7.1%.
Out of a total of 273 cases, 164 were male (60%) and 109 were female (40%). As shown in [Table 4], all diseases occurred more in male than female except UTI where female cases predominate.
|Table 4: Distribution of different renal diseases admitted during this period according to sex.|
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As shown in [Table 5], it is seen that nephrotic syndrome is most commonly seen in the age group of one to three years (32.5%). AGN is seen most commonly in the age group of 10–13 years (42.5%) and 7–9 years (42.5%). UTI most commonly occurred in 1–3 years age group (41.7%). AKI was seen more in 7–9 years age group (35.7%).
|Table 5: Distribution of different renal diseases admitted during this period according to age.|
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Only one case of total 273 cases (0.37%) had family history of renal disease. That case was a case of nephrotic syndrome (steroid responsive), whose brother also developed nephrotic syndrome within one year period.
| Discussion|| |
Renal diseases contribute significantly to morbidity in children. In our study, 7.17% of hospitalized children had renal disease. In a study done by Bhatta et al, in Nepal 6.3% of all admitted children had renal disease. In another study by Ali et al in Iraq admission due to renal diseases constituted 5.8% of the total pediatric admissions. In a previous study done by Sadeghi on spectrum of pediatric diseases in south Islamic Republic of Iran, reported a hospital admission of 8.7% of total pediatric admission due to renal cause.
In the present study, nephrotic syndrome (57.5%) was the most common renal cause of admission in hospital followed by acute glomerulonephritis (26.74%) which is similar to previous studies., Other studies have reported UTI as the most common cause of admission.,,, while others reported glomreulonephritis as the most common cause of admission due to renal disease.,
In the present study, out of total 273 cases of renal disease 164 (60.1%) were male and 109 (39.9%) were female with male:female ratio of 1.5:1. An earlier study by Bhatta et al has reported male:female ratio of 1.08:1. Derakhshan et al have reported a similar male:female ratio with males 52%, females 48%. All diseases occurred more in males than females except UTI where female cases predominated (8 males, 16 females, M:F ratio, 1:2) in our study. In the study by Derakhshan et al reported that UTI was three times more common in girls than in boys.
In the present study, it is observed that nephrotic syndrome is most commonly seen in the age group of one to three years (32.5%) followed by four to six years (28%). That means almost 60% of cases of nephrotic syndrome presented by six years of age. The age at onset in nephrotic syndrome in studies done by Habib and Kleinknecht and White et al was before the 4th year in 41 and 53%, respectively. One study by Srivastava et al showed that in 126 children out of 206 Indian children onset of nephrotic syndrome occurred before the age of five years. Study done by ISKDC found that almost 60% of the children with MCNS were from two to less than six years of age.
In the present study, most common cause of admission due to nephrotic syndrome was 1st attack (62.4%). Most of the cases were steroid responsive so MCNS. Only three cases had steroid resistance. Biopsy was done in the three cases and was found to have FSGS. Previous studies, have reported that most of the children with nephrotic syndrome were steroid sensitive having MCNS. Previous studies by Muthu et al and Gulati et al from India have reported that FSGS was the most common glomerular disease in adolescents.
APIGN was the most common cause of hospital admission due to glomerulonephritis (82.2% of glomerulonephritis cases, 22% of total renal admissions). In developing countries, the postinfectious glomerulonephritis (PIGN) remains the common cause of acute glomerulonepritis in children.,,,,
In the present study, septicemia was the most common cause of AKI (35.7%), followed by malaria, and APIGN. In a study by Krishnamurthy et al in southern India has found that the etiological profile of AKI was dominated by infections, including pneumonia, sepsis, meningoencephalitis, and tropical febrile illnesses. PSGN, snake envenomation, and HUS also contributed significantly.
In the present study, only one case of total 273 cases (0.37%) had a family history of renal disease, it was a case of steroidresponsive nephrotic syndrome. In the previous studies, by Habib and Kleinknecht 3.3% of cases of MCNS had siblings with the nephrotic syndrome, as did 2.5% cases of MCNS in the ISKDC. White et al found that the primary nephrotic syndrome, excluding the Finnish type of congenital nephrosis, which is clearly an autosomal recessive disease, was familial in about 3.5% of patients.
| Conclusion|| |
Our study provides insight into the pediatric renal problems. We have seen that a huge burden of pediatric morbidity is due to renal diseases. Majority of renal diseases such as MCNS and UTI can possibly be completely cured with proper and adequate treatment. A large pool of renal diseases are still due to infective etiology and thus preventable such as acute poststreptococcal glomerulonephritis, UTI, AKI due to malaria, and sepsis. Early recognition, timely treatment and regular follow-up are mandatory in the management of children with renal diseases.
Conflict of interest: None declared.
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Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]