End Stage Renal Disease – What can be done?
- End Stage Renal Disease - What can be done?
When a patient has kidney function of less than 15% of the normal functionality due to irreversible kidney disease and requires dialysis, he/she is said to have reached End Stage Renal Disease (ESRD).
In India, 150-200 people per million are affected by ESRD. Global incidence of chronic kidney failure in children is 5 per million children per year.
Kidney related problems in a growing fetus can be picked up during a routine abdominal ultrasound of the pregnant woman. If a detailed follow up is done, throughout the intra-uterine life of the affected baby, soon after its birth, defects can be corrected. Infections of the kidney early in life (within 2 years) if left unidentified and improperly investigated and treated would lead to scarring and irreversible damage. The symptoms pertaining Kidney diseases in children could be in the form of failure to thrive, vomiting, Pallor (Anaemia), and growth retardation. A high index of suspicion is necessary to diagnose Urinary Tract Infections and Renal problem in children.
The most common cause of ESRD is Diabetes Mellitus; it accounts for 30-40% of patients with ESRD. The other common causes for ESRD in India are Hypertension (14-22%), and Chronic Glomerulonephritis (16-20%).
Acute kidney failure can occur following severe infection, severe diarrhea and vomiting with dehydration, extensive bums, poisoning with toxic chemicals or drugs or as an allergic reaction to certain medication and this is often a temporary situation. Here, often timely treatment can retrieve the kidneys to near normalcy.
Chronic kidney failure occurs due to immunological disease affecting the kidney (Chronic Glomerulonephritis), Diabetes Mellitus, Hypertension, Genetic diseases affecting the kidney (Polycystic disease), blocking of the urinary passage for a prolonged period of time.
Children also suffer from ESRD. In this patient population, the most common causes of Renal failure are Obstructive Nephropathy (conditions causing obstruction to urinary flow that subsequently results in impaired kidney function), Reflux Nephropathy (impaired kidney function resulting from back flow of urine from urinary bladder into the kidneys and Chronic Glomerulonephritis. These three account for 75% of cases of ESRD.
The options include Maintenance Hemodialysis (MHD), Continuous Ambulatory Peritoneal Dialysis (CAPD), and renal transplantation.
Only 10% of new ESRD patients undergo one of these treatment options; 69% undergo MHD, 15% CAPD and 16% RT. Cost of dialysis per month could sometimes amount to the entire family income per month or even more than that.
Most of the kidney diseases in children are due to common treatable causes. The main advantage in a child’s kidney is that as a growing kidney, it has got the capacity to recover if timely treatment is administered. Whereas an adult kidney in which the process of damage had commenced in early childhood, but went undiagnosed, can succumb to an irreversible damage.
That an adult kidney (either from a living or cadaver donor) can be transplanted to a child who has suffered irreversible Kidney damage due to ESRD. A girl child who undergoes a kidney transplant can have a normal growth phase, including menarche- the onset of menstrual cycles.
Children cannot be subjected repeatedly to MHD because the blood volume is naturally less and the blood vessels are small, so CAPD is a better option.