“CLINICAL PROFILE OF RENAL DISEASES IN CHILDREN IN TERTIARY CARE CENTRE”

fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%) . Most common diagnosis was acute glomerulonephris (40%) followed by Nephroc syndrome (25%) and UTI (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependant nephroc syndrome. 5% of our cases expired because of MODS, sepsis and AKI. Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children. There is scanty data and need for detailed study on speciﬁc renal disease is of great need to plan opmal renal care for these children.


Introduc on
Renal diseases in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. The pa ern of renal disease in children is different from developing countries as compared to developed countries.

Objec ve
To know the current profile and ae ology of renal disease in children

Methodology
This is a hospital based prospec ve observa onal study carried from March, 2014 to February 2015 at BPKIHS. Pa ents with renal disease, both inpa ent and outpa ent from birth to 14 years of age were enrolled in the study. The diagnosis of renal disease was be made on clinical and laboratory criteria.

Result
Total of 120 pa ents were enrolled in our study which contributed to 3.74% of total admission. The commonest feature of presenta on was edema (75%) , followed by fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%) . Most common diagnosis was acute glomerulonephri s (40%) followed by Nephro c syndrome (25%) and UTI (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependant nephro c syndrome. 5% of our cases expired because of MODS, sepsis and AKI.

Conclusion
Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children. There is scanty data and need for detailed study on specific renal disease is of great need to plan op mal renal care for these children.

INTRODUCTION
The profile of childhood renal disease varies from one geographic region to another and even within the same 1-5. country. The presenta ons are different from developing countries as compared to developed countries and reported pediatric renal disease varies from 4.5-8.7 % of total 1,2 paediatric admission. The varia on is influenced by factors such as gene c predisposi on, environmental background and to a large extent the level of awareness. Renal disease in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. Renal disease in hospitalised children and young adult can be difficult to diagnose. Unexplained fever or failure to thrive may be the only manifesta on during infancy and early childhood. Standard defini on of the following renal diseases were used in our study. adjusted life years annually. Data describing the spectrum of renal diseases in children in Nepal is scanty, because of 7 lack of paediatric renal disease registry. The prevalence of 8 renal disease in asymptoma c school children is 0.71%. In addi on the annual inpa ent burden of pediatric renal disease is about 6.3%.

METHODOLOGY
It was a cross sec onal study done over a period of 1 year with the objec ve to quan fy the occurrence of renal diseases in children at BPKIHS a ter ary referral centre of eastern Nepal and to know the current pa ern and ae ology of renal disease to provide some insights to profile of renal diseases in children. We analysed all the pa ents coming to the department of paediatric and adolescent medicine diagnosed with renal disease over a period of one year from 1 March 2014 BPKIH.
st th to 28 February 2015 at Pa ent managed as outpa ent as well as hospitalized were included. Those denying for the consent and readmission were excluded from the study. The diagnosis of renal disease was made on history, clinical presenta on and laboratory criteria. The pa ern of presenta on, physical examina on and relevant inves ga on was recorded in a proforma. The children were divided in to several age groups. BMI, Height percen le and BP percen le were calculated according to standard reference. Ini al inves ga on such as complete blood count, erythrocyte sedimenta on rate, urine analysis, urine culture and sensi vity, serum electrolytes, blood urea and serum crea nine and further inves ga on done as needed including renal ultrasonography, intravenous urogram, mictura ng cystourethrography, serum cholesterol and protein, An Streptolysin O ter, 24 hour urinary protein es ma on, dsDNA, renal biopsy and Hepa s surface an gen was recorded. Diagnosis and management including special management like dialysis was recorded. Each pa ent was followed from admission to discharge on a daily basis and discharged cases were kept under regular follow up in our special Renal OPD. Data regarding informa on about demography, clinical features, examina ons, inves ga ons, and main hospital discharge diagnosis, use of invasive devices, referral and final outcome were prospec vely collected and recorded in a pre designed proforma. Informed wri en consent was taken and the ethical codes were followed. Further wri en consent was taken while performing renal biopsy. Relevant data were entered from proforma in Excel and a master chart was prepared. Data were analyzed using Sta s cal Package for the Social Sciences (SPSS) version 20.0. For Descrip ve sta s cs mean, standard devia on (SD), range, percentage, propor ons were calculated. And also graphical as well as tabular presenta ons were made while preparing results. For inferen al sta s c in comparing categorical variable Pearson's chi-square test was used and to compare mean independent T-test and ANOVA test were used at 95%confidence interval. Sta s cal significance was considered at p values <.05 and that of <0.001 was termed as highly significant.

RESULTS
During the study period a total of 120 cases with renal disease were enrolled. The age and sex distribu on of cases is shown in table 1.    (Table-3  Renal biopsy as a part of diagnos c work-up was done in 12 paients. The commonest finding in renal biopsy was minimal change disease (41.66%), followed by mesangio prolifera ve glomerulonephri s (MPGN) (16.66%) and with 1 case each of FSGS, ALPORT, MPGN, SLE-3 and SLE-4. Out of 120 cases, 104 (86.66%) cases improved and discharged home and 8.33% cases were referred to other centre for biopsy and advanced treatment. While 6 pa ents expired with cause of death as shown in table 7.

Table 4: Causes of expired cases
Since the most common disease were AGN and NS these pa ents were further categorised as shown in table 5. Most st cases of nephro c syndrome presented as 1 episode (31.25%) with mean age of 5 years followed by infrequent relapse nephro c syndrome (26.66%).  As shown in Table 6, albuminuria (65.5%) was one of the commonest presenta ons of nephro c syndrome followed by hypertension and renal derangement.

DISCUSSION
Pediatric renal diseases are common in our society. Diagnosis is difficult at mes due to diverse clinical manifesta on. Thus early diagnosis and interven on can be boosted by the knowledge of current trends in paediatric renal disease. In our series, edema was the commonest symptom at presenta on (75%) followed by fever (65%), oliguria (45%) and hematuria(25%). 60% were hypertensive 7 in our study. In a study conducted by Malla T et al 51% were fever, 46% were edema, followed by hypertension (39%), hematuria (38%) and oliguria (31%). So edema, fever, hypertension, oliguria were higher in our study whereas hematuria were less in our study. Out of 120 cases enrolled in the study, AGN was the commonest renal problem (40%). The causes were infec ous PIGN, Lupus nephri s, HSP nepri s. The results 3 were comparable to study done by Bha a NK et al .
Regarding gender, in our study, 57.5% were male and 42.5% were female. In nephro c syndrome were 63.33% male and 36.66% were female which is comparable in study done by 7 Malla T et al While in AGN 47.91% were male versus 52.08% were female, but in contrast female are less compared to male in same study. Among cases of AGN, the causes were infec ous PIGN, Lupus nephri s, HSP nephri s. The results were comparable 3 12 to study done by Bha a NK et al and A.Y. Elzouki et al. In our study, a er AGN, nepro c syndrome was the second most common disease which is similar to study by Etuk IS et 14 15 al  16,17 similar to as reported earlier in other studies. Common mode of presenta on of AGN were hypertension (87.5%), followed by hematuria (85.41%), proteinuria less than or equal to 2 (60.41%). Among complica on HTN encephalopathy (10.41%) most common followed by CCF (8.33%) and nephro c range proteinuria (8.33%). Isaac E. 9 Ocheke et al documents hypertension (92.3%) as commonest presenta on followed by oliguria (88.5%) and hypertensive encephalopathy (23.1%) being the commonest complica on. The finding suggests that modes of presenta on were similar but rela vely lower complica on in our study. In our study, 25% cases of UTI were present (not shown in

CONCLUSION
Late presenta on and inability to afford interven onal measures including renal replacement therapy were the main constrain among these pa ents. Implica on of this findings emphasis need of rou ne screening for renal disease so that evidence of kidney damage can be iden fied early enough. The early detec on of renal diseases in childhood leads to be er therapy and reduc on in morbidity and mortality. The present study depicts clinical profile of renal disease and a empts to find out burden of renal diseases. As facili es for treatment is either too expensive or not available, many children die before ge ng op mal treatment or present late in the course of disease, where mely interven on is required to improve outcome.

LIMITATION OF STUDY
This study has smaller sample size so to know further pa ern of renal disease in pediatric popula on large scale study is to be done.