Preliminary study: the challenge of providing tertially care for renal disease in children admitted to the University Teaching Hospital, Zambia

Abstract

Renal disease in children commonly presents as nephrotic syndrome of the minimal change type, glomerulonephritis, and or a combined nephritic-nephrotic clinical picture. When not responsive to steroid, underlying focal segmental sclerosis is usually attributed to diseases like malaria, schistosomiasis and a host of viral diseases with high mortality outcomes. In order to understand the profile of renal disease and the outcome obtained in a resource constrained University Teaching Hospital, without access to renal biopsy, a study of 34 children referred to the renal clinic, for tertiary care in 2003, was done. Objective: To determine the type and clinical outcome of renal diseases in children referred to the University Teaching Hospital, Department of Paediatrics and Child Health. Methods: A1134 case records available in the Paediatric Renal Diseases clinic, in the Department of Paediatrics and Child Health, University Teaching Hospital, were reviewed retrospectively and data analysed manually and with EPI-info, 2002 Version. Results: The commonest reasons for referral were 91 omerulonephritis and nephrotic syndrome, accounting for 27 out of 34 cases. Others were haemolytic uraemic syndrome, schistosomiasis and HIV nephropathy. At the last review in the clinic, 16 had made full recovery, 7 were still symptomatic with either and or raised blood pressure, proteinuria or oedema, 7 died, while 4 were lost to follow up. This preliminary study demonstrates improved clinical diagnosis in the post referral period. Good history,physical examination, accurate blood pressure monitoring, basic urine chemistry and microscopy of the urine, together with a clear understanding of steroid responsiveness. and judicious use of antibiotic, anti-hypertensive and supportive care, does achieve improved clinical diagnosis and subsequent improved clinical care. Conclusion: A good history, physical examination and basic investigation provide sufficient diagnostic criteria for the most common renal conditions like nephrotic syndrome and nephritis, in a resource-constrained setting like Zambia. There is need to routinely test all children categorized as partially or non-responsive to steroids, for HIV, and other infections such as malaria. Medical treatment of nephritis and nephrotic syndome should result in improvement in more than half of the patients. Though the numbers seem few, the health system needs to cater more comprehensively for paediatric renal pathology.