Perspectives: Neonatal acute kidney injury (AKI) in low and middle income countries (LMIC).

Neonatal AKI (NAKI) remains a challenge in low- and middle-income countries (LMICs). In this perspective, we address issues of diagnosis and risk factors particular to less well-resourced regions. The conservative management pre-kidney replacement therapy (pre-KRT) is prioritized and challenges of KRT are described with improvised dialysis techniques also included. Special emphasis is placed on ethical and palliation principles.

The Financial Cost Incurred by Families of Children on Long-Term Dialysis.

BACKGROUND: Costs of dialysis reported in countries where dialysis is government-funded are often those incurred by the state, and only a few take into account the financial burden to the family of the index patient. This study investigated the financial cost implication to families of pediatric patients on maintenance dialysis and how aid provided by the government alleviates their financial burden. METHODS: This descriptive cross-sectional study recruited 24 children on peritoneal dialysis (PD) and hemodialysis (HD), and a structured questionnaire was administered to the parents/caregivers of these patients to obtain information on their family size, total family income, cost of transportation, employment status of attending caregiver, and number of work days missed due to hospital visits. RESULTS: Complete data were available for 19 patients (7 on PD and 12 on HD). The mean age was 14 ± 6 years, and there were 11 males and 8 females. The average monthly income of the families recruited was 2,946 ZAR (261 USD). This amount included the contribution of a monthly state-provided social grant of 1,300 ZAR (115 USD) in 16/19 subjects. The average monthly expenditure of the HD and PD groups made up 27.1% and 4.9% of their average income. CONCLUSION: Transport cost for our patients on dialysis significantly impacts on the overall family income, especially for patients on HD, and, without government aid, the families of our patients would have far less money available for their daily needs.

Idiopathic nephrotic syndrome in South African children.

BACKGROUND: Different histo-pathological types and treatment response patterns of Idiopathic nephrotic syndrome (INS) have been associated with differences in ethnicity and geographical location. OBJECTIVE: To provide an update on the steroid response and renal histo-pathological pattern in children treated for INS. METHOD: Medical records of children with INS treated at the Charlotte Maxeke Johannesburg Academic Hospital were reviewed. RESULTS: Mean age was 5.3 years ± 2.8. The majority (68.1%) of the 163 children were of the black racial group. The highest rate of INS was seen in the 2-6 year age group (71.2%). The black racial group had the highest rate (42/111; 37.8%) of focal segmental glomerulosclerosis (FSGS), and the white race had the highest rate (9/14; 64.3%) of minimal change disease (MCD). Ninety four (57.7%) patients were steroid sensitive (SSNS) while 69 patients (42.3%) were steroid resistant (SRNS). Minimal change disease was the most common histo-pathological type seen in SSNS (60%), while FSGS was the most common observed in patients who had SRNS (65.2%). CONCLUSION: There appears to be a higher rate of FSGS in all the racial groups, and also a higher rate of MCD in the black race group, when compared to previous reports.