Clinical Profile of Chronic Kidney Disease in Children

Background: CKD is an important cause of mortality, morbidity and impaired quality of life in children. Data in paediatric population is sparse from this part of the country. A better understanding about the epidemiology and preventable factors can help in better management of these children. Aims: To study the etiology and clinical profile of the children with chronic kidney disease who attended Gauhati Medical College and Hospital, Assam. Materials and methods: The demographic, clinical profile and biochemical data of the children diagnosed with CKD, admitted in our Institute from August 2013-July 2016 were analysed retrospectively. CKD was defined according to NKF-K/DOQI 2002 clinical practice guideline with GFR below 60ml/min/1.73m2 estimated by modified Schwartz formula. Records were reviewed to search for their etiology and clinical profile like height, weight, BMI, presence of anaemia or hypertension. Also outcome where available were recorded. Results: Among 101 children diagnosed as CKD, 65 (64.35%) were boys. The mean age of presentation was 14.87years of age (range 3 yrs to 18yrs). Only 4 children were less than 5 years of age. The mean GFR at presentation was 14.67ml/min/1.73m2.61% of the children were already in CKD stage 5. The causes of CKD included glomerular diseases (35.6 %,), interstitial and obstructive causes (38.61%), miscellaneous (6.9%) and undetermined (18.81%). Among glomerular causes chronic GN (15.84%) was most common, followed by FSGS (8.91%) and IgA nephropathy (4.95%). Reflux nephropathy was seen in 10.89% and obstruction in 9.9%. Most patients were anaemic with mean haemoglobin at time of admission of 6.4gm/dl. By the end of the study period 8 children had undergone transplantation, 22 children were undergoing conservative therapy, and 42 children were lost to follow up. Conclusions: Obstructive and interstitial nephritis comprises a large subgroup of CKD in children from this region. Most of the children carry poor prognosis in view of their late presentation. Majority of the children were unable to undergo any effective therapy and were lost to follow up in view of limited availability and high cost of therapy.