Skip to main content

Advertisement

Log in

Pediatric Nephrology in Low Resource Countries — Challenges and Opportunities

  • Published:
Current Pediatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

This review highlights the challenges in providing optimal care to children with kidney disease in low-resource countries globally. It also underscores the potential opportunities and solutions to improve care.

Recent Findings

The spectrum of diseases affecting the kidneys is different in low-resource countries. In addition to variations in the availability of diagnostic and therapeutic resources, financial, and logistic challenges act as barriers to optimal care. Innovations and improvisation of available local resources provide promising solutions. The role of national and international organizations, along with local and regional authorities in improving healthcare availability and accessibility is the way forward.

Summary

The challenges of pediatric nephrology in low-resource countries are related to the spectrum of disease and availability and access to healthcare resources. Pediatric nephrology care can be enhanced through collaborative efforts to improve overall healthcare status in line with the United Nations Sustainable Developmental Goals 2030.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. World Bank Open Data | Data [Internet]. [cited 2023 Apr 25]. Available from: https://data.worldbank.org/. Accessed on 26.3.2023.

  2. McCulloch M, Luyckx VA, Cullis B, Davies SJ, Finkelstein FO, Yap HK, et al. Challenges of access to kidney care for children in low-resource settings. Nat Rev Nephrol. 2021;17:33–45. Gives an overview of challenges of access to kidney care in resource limited regions.

    Article  PubMed  Google Scholar 

  3. Olowu WA, Ademola A, Ajite AB, Saad YM. Childhood nephrotic syndrome in tropical Africa: then and now. Paediatr Int Child Health. 2017;37:259–68.

    Article  PubMed  Google Scholar 

  4. Chanchlani R, Parekh RS. Ethnic differences in childhood nephrotic syndrome. Front Pediatr. 2016;4:2–7.

    Article  Google Scholar 

  5. Esezobor CI, Solarin AU, Gbadegesin R. Changing epidemiology of nephrotic syndrome in Nigerian children: a cross-sectional study. PLoS ONE. 2020;15:e0239300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatr Nephrol. 2022;37:959–72. Review focussing on pediatric nephrology in under resourced regions.Provides data from global survey.

    Article  PubMed  Google Scholar 

  7. Mitra S, Banerjee S. The impact of pediatric nephrotic syndrome on families. Pediatr Nephrol. 2011;26:1235–40.

    Article  PubMed  Google Scholar 

  8. Ong LT. Management and outcomes of acute post-streptococcal glomerulonephritis in children. World J Nephrol. 2022;11:139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dewan D, Gulati S, Sharma RK, Prasad N, Jain M, Gupta A, et al. Clinical spectrum and outcome of crescentic glomerulonephritis in children in developing countries. Pediatr Nephrol. 2008;23:389–94.

    Article  PubMed  Google Scholar 

  10. Li Y, Yang Y, Zhuo L, Wu D, Li W, Liu X. Epidemiology of biopsy-proven glomerular diseases in Chinese children: a scoping review. Chronic Dis Transl Med. 2022;8:271–80.

    PubMed  PubMed Central  Google Scholar 

  11. Fredrick F, Francis JM, Ruggajo PJ, Maro EE. Renal abnormalities among HIV infected children at Muhimbili National Hospital (MNH) - Dar es Salaam, Tanzania. BMC Nephrol. 2016;17:30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kaze FF, Kengne AP, Atanga LC, Lobe MM, Menanga AP, Halle MP, et al. Kidney function, urinalysis abnormalities and correlates in equatorial Africans with sickle cell disease. Clin Kidney J. 2013;6:15–20.

    Article  PubMed  Google Scholar 

  13. Khandelwal P, Govindarajan S, Bagga A. Management and outcomes in children with lupus nephritis in the developing countries. Pediatr Nephrol. 2023;38:987–1000.

    Article  PubMed  Google Scholar 

  14. Hofer J, Giner T, Safouh H. Diagnosis and treatment of the hemolytic uremic syndrome disease spectrum in developing regions. Semin Thromb Hemost. 2014;40:478–86.

    Article  PubMed  Google Scholar 

  15. Bagga A, Khandelwal P, Mishra K, Thergaonkar R, Vasudevan A, Sharma J, et al. Hemolytic uremic syndrome in a developing country: consensus guidelines. Pediatr Nephrol. 2019;34:1465–82.

    Article  PubMed  Google Scholar 

  16. Soliman NA, Rizvi SAH. Endemic bladder calculi in children. Pediatr Nephrol. 2017;32:1489–99.

    Article  PubMed  Google Scholar 

  17. Rizvi SA, Sultan S, Ijaz H, Mirza ZN, Ahmed B, Saulat S, et al. Open surgical management of pediatric urolithiasis: a developing country perspective. Ind J of Urol. 2010;26:573–6.

    Article  Google Scholar 

  18. Okafor HU, Ekenze SO, Uwaezuoke SN. Posterior urethral valves: determinants of outcome in a developing country. J Paediatr Child Health. 2013;49:115–9.

    Article  PubMed  Google Scholar 

  19. Bamgbola O. Urinary schistosomiasis. Pediatr Nephrol. 2014;29(11):2113–20.

    Article  PubMed  Google Scholar 

  20. Kari JA. Neuropathic bladder as a cause of chronic renal failure in children in developing countries. Pediatr Nephrol. 2006;21:517–20.

    Article  PubMed  Google Scholar 

  21. Che R, Quadri MM, Zhang A. The epidemiology and management of pediatric AKI in Asia. Sem Nephrol. 2020;40:516–32.

    Article  Google Scholar 

  22. Macedo E, Cerdá J, Hingorani S, Hou J, Bagga A, Burdmann EA, et al. Recognition and management of acute kidney injury in children: The ISN 0by25 Global Snapshot study. PLoS One. 2018;13:1–15. Discusses the challenges of management of AKI in lo resource settings.

    Article  Google Scholar 

  23. Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2016;4(4):e242–50. Discusses the outcomes of AKI in low resource countries of Africa.

    Article  PubMed  Google Scholar 

  24. Esezobor CI, Alakaloko AE, Admani B, Ellidir R, Nourse P, McCulloch MI. Paediatric Nephrology in Africa. Curr Ped Rep. 2021;9:134–41.

    Article  Google Scholar 

  25. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2013;8:1482–93.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Azarudeen M, Kamath N, Lalitha AV, Vasudevan A. Clinical profile and outcomes of emergencies in pediatric chronic kidney disease. Indian Pediatr. 2021;59:31–4.

    Article  PubMed  Google Scholar 

  27. Kamath N, Iyengar A, George N, Luyckx VA. Risk factors and rate of progression of CKD in children. Kidney Int Rep. 2019;4:1472–93.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kamath N, Iyengar AA. Chronic Kidney Disease (CKD): An observational study of etiology, severity and burden of comorbidities. The Indian Journal of Pediatrics. 2017;84:822–5.

    Article  PubMed  Google Scholar 

  29. Montini G, Edefonti A, Galán YS, Sandoval Díaz M, Medina Manzanarez M, Marra G, et al. Non-medical risk factors as avoidable determinants of excess mortality in children with chronic kidney disease. A prospective cohort study in Nicaragua, a model low income country. PLoS One. 2016;11(5):e0153963.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Harambat J, Van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27(3):363–73.

    Article  PubMed  Google Scholar 

  31. Schaefer F, Borzych-Duzalka D, Azocar M, Munarriz RL, Sever L, Aksu N, et al. Impact of global economic disparities on practices and outcomes of chronic peritoneal dialysis in children: Insights from the international pediatric peritoneal dialysis network registry. Perit Dial Int. 2012;32:399–409.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sinha A, Bagga A. Maintenance dialysis in developing countries. Pediatr Nephrol. 2015;30:211–9.

    Article  PubMed  Google Scholar 

  33. Niang A, Iyengar A, Luyckx VA. Hemodialysis versus peritoneal dialysis in resource-limited settings. Curr Opin Nephrol Hypertens. 2018;27:463–71.

    Article  PubMed  Google Scholar 

  34. Hasan Rizvi SA, Anwar Naqvi SA, Ahmed E. Renal transplantation in developing countries. Kidney Dis Dev World Ethn Minorities. 2005;63:211–45.

    Article  Google Scholar 

  35. Rizvi SAH, Sultan S, Zafar MN, Naqvi SAA, Lanewala AA, Hashmi S, et al. Pediatric kidney transplantation in the developing world: challenges and solutions. Am J Transplant. 2013;13:2441–9.

    Article  CAS  PubMed  Google Scholar 

  36. Spearman CWN, McCulloch MI. Challenges for paediatric transplantation in Africa. Pediatr Transplant. 2014;18:668–74.

    Article  CAS  PubMed  Google Scholar 

  37. Emmes Corporation. Collaborative studies NAPRTCS 2014 annual transplant report. 2014;102. Available from: https://web.emmes.com/study/ped/annlrept/annualrept2014.pdf. Accessed 18 Mar 2023

  38. Iyengar A, Mcculloch MI. Paediatric kidney transplantation in under-resourced regions-a panoramic view. Pediatr Nephrol. 2022;37:745–55. Gives an overview of challenges in access to transplantation in low resource stings.

    Article  PubMed  Google Scholar 

  39. Mubarak M. Practicing renal transplant pathology in a developing country: challenges and opportunities. J Transplant Technol Res. 2012;02(03).

  40. Defaye FB, Desalegn D, Danis M, Hurst S, Berhane Y, Norheim OF, et al. A survey of Ethiopian physicians’ experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences. BMC Health Serv Res. 2015;15:467.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Iyengar A, Lewin S, Lantos JD. Considering family resources when making medical recommendations. Pediatrics. 2018;1:141.

    Google Scholar 

  42. Glenn D, Ocegueda S, Nazareth M, Zhong Y, Weinstein A, Primack W, et al. The global pediatric nephrology workforce: a survey of the International Pediatric Nephrology Association. BMC Nephrol. 2016;17:83.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Raina R, Chauvin AM, Bunchman T, Askenazi D, Deep A, Ensley MJ, et al. Treatment of AKI in developing and developed countries: an international survey of pediatric dialysis modalities. PLoS ONE. 2017;12:e0178233.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lalji R, Francis A, Wong G, Viecelli AK, Tong A, Teixeira-Pinto A, et al. Disparities in end-stage kidney disease care for children: a global survey. Kidney Int. 2020;98:527–32. Highlights the inequity in care of children with kidney failure.

    Article  PubMed  Google Scholar 

  45. Tummalapalli SL, Shlipak MG, Damster S, Jha V, Malik C, Levin A, et al. Availability and affordability of kidney health laboratory tests around the globe. Am J Nephrol. 2021;51:959–65.

    Article  Google Scholar 

  46. Francis A, Abdul Hafidz MI, Ekrikpo UE, Chen T, Wijewickrama E, Tannor EK, et al. Barriers to accessing essential medicines for kidney disease in low- and lower middle–income countries. Kidney Int. 2022;102:969–73.

    Article  PubMed  Google Scholar 

  47. Abdelraheem M, Ali ET, Osman R, Ellidir R, Bushara A, Hussein R, et al. Outcome of acute kidney injury in sudanese children - an experience from a sub-saharan African unit. Perit Dial Int. 2014;34:526–33.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Esezobor CI, Ladapo TA, Lesi FE. Peritoneal dialysis for children with acute kidney injury in Lagos, Nigeria: experience with adaptations. Perit Dial Int. 2014;34:534–8.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ademola AD, Asinobi AO, Ogunkunle OO, Yusuf BN, Ojo OE. Peritoneal dialysis in childhood acute kidney injury: experience in Southwest Nigeria. Perit Dial Int. 2012;32:267–72.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Santos CR, Branco PQ, Gaspar A, Bruges M, Anjos R, Gonçalves MS, et al. Use of peritoneal dialysis after surgery for congenital heart disease in children. Perit Dial Int. 2012;32:273.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Abdou N, Antwi S, Koffi LA, Lalya F, Adabayeri VM, Nyah N, et al. Peritoneal dialysis to treat patients with acute kidney injury—the saving young lives experience in West Africa: proceedings of the saving young lives session at the first international conference of dialysis in West Africa, Dakar, Senegal, December 2015. Perit Dial Int. 2017;37:155–8.

    Article  PubMed  Google Scholar 

  52. Palmer D, Lawton WJ, Barrier C, Fine BD, Hemphill H, NdiNyah N, et al. Peritoneal dialysis for AKI in Cameroon: commercial vs locally-made solutions. Perit Dial Int. 2018;38:246–50.

    Article  PubMed  Google Scholar 

  53. Nourse P, Cullis B, Finkelstein F, Numanoglu A, Warady B, Antwi S, et al. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (Paediatrics). Peritl Dial Int. 2021;41:139–57.

    Article  Google Scholar 

  54. Kamath N, Reddy HV, Iyengar A. Clinical and dialysis outcomes of manual chronic peritoneal dialysis in low-body-weight children from a low-to-middle-income country. Perit Dial Int. 2020;40:6–11.

    Article  PubMed  Google Scholar 

  55. Iyengar A, Kamath N, Phadke KD, Bitzan M. Cyclosporine/ketoconazole reduces treatment costs for nephrotic syndrome. Indian J Nephrol. 2013;23:419–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Hari P, Alhasan K, Bagga A, Bonilla-Felix M, Coccia PA, Duzova A, et al. Importance of clinical practice guidelines to practicing pediatric nephrologists and IPNA survey. Pediatr Nephrol. 2021;36:3493–7.

    Article  PubMed  Google Scholar 

  57. Esezobor C, Ademola AD, Adetunji AE, Anigilaje EA, Batte A, Jiya-Bello FN, et al. Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement. Kidney Int. 2021;99:59–67.

    Article  CAS  PubMed  Google Scholar 

  58. Guidelines on hemolytic uremic syndrome by Indian Society of Pediatric Nephrology: key messages. Indian Pediatr. 2020;57:744–747.

  59. The top 10 causes of death [Internet]. [cited 2023 Apr 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death. Accessed on 29.4.2023.

  60. See EJ, Alrukhaimi M, Ashuntantang GE, Bello AK, Bellorin-Font E, BenghanemGharbi M, et al. Global coverage of health information systems for kidney disease: availability, challenges, and opportunities for development. Kidney Int Suppl. 2018;8:74–81.

    Article  Google Scholar 

  61. Ploos Van Amstel S, Noordzij M, Warady BA, Cano F, Craig JC, Groothoff JW, et al. Renal replacement therapy for children throughout the world: the need for a global registry. Pediatr Nephrol. 2018;33:863–71.

    Article  PubMed  Google Scholar 

  62. Economic evaluation of clinical quality registries | Australian Commission on Safety and Quality in Health Care. Available from: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/economic-evaluation-clinical-quality-registries. Accessed on 29.4.2023.

  63. Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, et al. Sustainable development goals relevant to kidney health: an update on progress. Nat Rev Nephrol. 2021;17:15–32. Highlights how kidney care can be achieved by commitment to the sustainable developmental goals.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nivedita Kamath.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamath, N., Felix, M.B. Pediatric Nephrology in Low Resource Countries — Challenges and Opportunities. Curr Pediatr Rep 11, 96–103 (2023). https://doi.org/10.1007/s40124-023-00291-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40124-023-00291-6

Keywords

Navigation