Paediatric Nephrology: Current situation in Bangladesh

The paediatric population constitute about 47% of
the total population. Of these, about 5% are suffering
from some form of kidney diseases. It has been
estimated that each year about 50,000 patients are
developing kidney failure and out of them, about 90%
patient die without any effective treatment. The
number of kidney patients are increasing every year
because of infection, toxins, environmental factors,
genetic diseases and congenital anomalies.
A separate Paediatric Nephrology setup was initiated
at BSMMU in 1982 because of increasing number of
patients developing acute renal failure, the cause of
which was not identified until 1992. It was found
that, adulteration of paracetamol syrup with Diethyline
glycol was responsible for those tragic deaths
of thousands of children. Subsequently the Pediatric
Nephrology unit was established in Dhaka Shishu
Hospital (1986) and the National Institute of Kidney
Diseases & Urology (2003).
In 2010 Government created 43 new posts in different
Medical Institutes to establish Paediatric Nephrology
as a separate entity. But due to lack of ancillary
support, separate Pediatric Nephrology department
is yet to develop in other medical colleges.
Bangladesh is a developing country. Majority of
kidney patients are poor and without support, their
treatment is not possible. Most of them have been
suffering from urinary tract infection, acute post
streptococcal glomerulonephritis, nephritic
syndrome, acute kidney injury due to diarrhoea &
Paediatric Nephrology: Current situation in
Prof. Mohammed Hanif
dehydration and congenital anomalies in the form
of obstructive uropathy.
Most of the above diseases could be prevented if
detectd early or if expert services are provided.
Improvement of training facilities , post graduate
education and research facilities can also help to
improve this situation. Antenatal diagnosis of the
genetic diseases and congenital anomalies are
important for early detection, treatment of these
diseases & to prevent CKD. Beside these, collagen
vascular diseases, metabolic diseases are also not
uncommon. Facilities for the treatment of patients
with CKD, in the form of renal replacement therapy
or pediatric renal transplantation are extremely
limited. So far kidney transplantation were done in
3 patients at BSMMU with limited resources.
Transplantation facilities in other centers are yet to
Early detection and prevention of paediatric kidney
problems are important to prevent CKD in adult life
and also to reduce the health budget and suffering
of the patients with limited resources. All the medical
institutes should have facilities for treating these
children with the facilities for renal replacement
therapy in the form of peritoneal dialysis, continuous
ambulatory peritoneal dialysis (CAPD) and
haemodialysis. Development of affordable effective
medication and preventive strategies are required
by research work to reduce the suffering of these
poor patients in this country.

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