Section one
INTRODUCTION
Pediatric nephrology a subspeciality of pediatrics has become well recognized since the late 1980s. Earlier, pediatricians were caring for children with renal disorders. But, when confronted with difficult renal problems or when they found it difficult to manage, these children were referred to adult nephrologists. They in turn with their expertise in nephrology helped the pediatricians in managing pediatric renal problems.
In the last 20–25 years the scenario is fast changing. Children with renal problems are managed either by qualified pediatric nephrologists or by pediatricians with adequate training and knowledge in pediatric nephrology. The adult nephrologists, with increasing load of dialysis and transplant work are willing to refer childhood renal problems to pediatric nephrologists. Overall, the importance of pediatric nephrology and pediatric nephrologists has become popular to everyone concerned with medicare. Parents also directly seek medicare from pediatric nephrologists.
Pediatric Nephrology Centers in India
Pediatric nephrology centers and pediatric medical institutions providing “Pediatric Nephrology Care” are now available at Chennai, Delhi, Mumbai, Bangalore and Lucknow with good clinical nephrology expertise and facilities for dialysis and transplantation. These centers have become centers of excellence and also impart training in pediatric nephrology.
Role of Indian Academy of Pediatrics
Indian Academy of Pediatrics with a good foresight encouraged development of pediatric subspecialities in IAP and this move gave a great fillip to develop further. Pediatricians with interest came together under this subspeciality of IAP, “Pediatric Nephrology”. This group has started a “Newsletter” which can disseminate adequate and useful information on “Pediatric Nephrology” to members of IAP. Various “Fellowship and Training programmes” are being conducted by this group at various recognized centers of India to impart essential knowledge of “Pediatric Nephrology” to the young and energetic pediatric colleagues. It is a positive sign that the number of well-trained pediatricians and pediatric nephrologists will increase and will help children to get optimal pediatric nephrology 2care. IAP also encourages pediatric nephrology training inside and outside India through various “Training Fellowship Programmes”. In essence, every effort is taken by IAP and “Pediatric Nephrology Subspeciality” of IAP to improve the “Pediatric Nephrology Care” in India.
Various consensus statements for common problems like management aspects in UTI, nephrotic syndrome and antenatally detected hydronephrosis are being prepared by the group, which is a good beginning for a better and uniform care for children with renal disorders. A stage should come wherein children with renal disease will be looked after by pediatricians for primary and secondary nephrological care and pediatric nephrologist will be called in for expert tertiary care. This stage of development is highly essential as primary pediatricians treat 90–95% of renal problems. Adequate exposure, knowledge and training of pediatric nephrology are highly needed to reach this goal. For this to occur pediatric training for postgraduates should aim at training in various concepts of nephrology so as to make young doctors with qualifications in pediatrics, self-sufficient to manage pediatric renal problems. A good pediatrician is one who knows who are the children he should look after and who need to be referred to higher centers. “Simple Referral” should be modified to “Essential Referral” after adequate primary pediatric nephrology care by pediatricians themselves. This step is highly needed to make our children get adequate pediatric nephrology care in our modern health care system.
Development of Pediatric Nephrology in India and Hope for the Future
In last two decades there has been a perceptible change in the management of renal diseases by the pediatricians in the community. The knowledge and expertise available in the few centers, particularly in the teaching institutions, has permeated into the grass root level pediatricians in the villages and towns, thanks to the various training programmes, workshops and CMEs conducted by the district and state branches of IAP and by the IAP at the national conferences. Gone are the days when the children with congenital malformations of the urinary tract with UTI were seen in severe renal failure. Now, with availability of antenatal USG, investigatory modalities, early intervention, prevention and early recognition of infection, prevents many children from developing permanent renal damage and terminal renal failure. Gone are the days when the children with ESRD were allowed to die. Hope of transplant is available for these children albeit not for all. Pediatricians have been adequately and well sensitized to the management of the three common renal problems, UTI, acute nephritic syndrome and nephrotic syndrome. But there are large areas to be conquered, the problem of steroid resistant nephrotic syndrome, fluid and electrolyte disturbances due to inherited tubular disorders and the development of fetal surgery. With the opening up of the floodgates of information technology and access to laboratory facilities in the developed countries, though costly, it is only a matter of time that the above problems can be treated. The world of “Pediatric Nephrology” is still not completely explored and we invite young pediatricians to join us in our efforts to complete it.
BIBLIOGRAPHY
- Vijayakumar M, Nammalwar BR. Need for pediatric nephrology care in India. Indian J Prac Pediatr, 2002;4:197–198