ArticlePDF Available

Epidemiology of chronic kidney disease in a Pakistani population

Saudi J Kidney Dis Transpl 2015;26(6):1307-1310
© 2015 Saudi Center for Organ Transplantation
Letter to the Editor
Epidemiology of Chronic Kidney Disease in a Pakistani Population
To the Editor,
Chronic kidney disease (CKD) is progres-
sively increasing in south Asian countries like
Pakistan, and the reason for this spread is
multi-factorial. Most of the people have inade-
quate health-care provision due to either lack
of health education, lack of primary health-
care, inadequate funding on the part of the
government and, most importantly, the increa-
sing prevalence of risk factors for CKD such
as diabetes and hypertension.1 In addition,
other causes like glomerulonephritis and renal
stones are prevalent due to infections and dry
weather conditions.
Lack of a central registry makes epidemio-
logical assessment extremely difficult and in-
adequate in Pakistan. Most of the data regarding
disease burden estimates are mostly center-
based. Our nephrology unit, which is part of a
large tertiary care hospital, the Pakistan
Institute of Medical Sciences, Islamabad caters
to a large population in the region. The ave-
rage population served by this center is large
and the catchment area includes a vast area of
Punjab, Khyber and Kashmir (the three pro-
vinces). We have a separate dedicated CKD
This study evaluates the etiology of CKD
among patients presenting at our center.
This was a cross-sectional study of four
months duration conducted in the Nephrology
Department of the Pakistan Institute of Medical
Sciences, Islamabad from September till
December of 2013.
A case record form was used to record demo-
graphic details, stage of renal disease and pos-
sible etiology of patients with established CKD.
The data was obtained from patient interviews,
diagnosis charts and case records, ultrasound
scan reports and renal biopsy findings.
We included all patients with a diagnosis of
established CKD who visited our outpatient
department or were admitted in our ward
during the study duration. The possible cause
of CKD was evaluated as follows. A diagnosis
of diabetic nephropathy was established based
on the presence of confirmed diabetes mellitus
and one of the following criteria: Long-
standing diabetes preceding CKD (minimum
of 10 years), normal-sized kidneys on ultra-
sound or presence of established diabetic
retinopathy by fundoscopy. CKD due to
hypertension was established based on history
of hypertension (minimum of five years) pre-
ceding renal dysfunction, evidence of hyper-
tension-related end-organ damage and exclu-
sion of other renal diseases.
A diagnosis of chronic tubulo-interstitial di-
sease was made based on history of polyuria,
nocturia with low-specific gravity of urine and
low or normal blood pressure associated with
small kidneys on ultrasound.
The other etiologies of CKD were determined
based on renal biopsy and ultrasound findings.
The stage of CKD was established by recor-
ding the most recent (within the last three
months) eGFR according to the (Modification
of Diet in Renal Disease (MDRD) equation.
Reports from Pakistan have shown that eGFR
measured by the Cockcroft Gault or MDRD
formula is a better predictor of reduced GFR
Saudi Journal
of Kidney Diseases
and Transplantation
[Downloaded free from on Wednesday, September 28, 2016, IP:]
than serum creatinine alone in the Pakistani
population.1CKD staging was performed
according to the Kidney Disease Outcomes
Quality Initiative (K/DOQI) guidelines.
Informed consent was obtained from every
individual studied. Ethical approval was ob-
tained from the Ethics Review Committee of
the Pakistan Institute of Medical Sciences,
Study data were analyzed using SPSS version
A total of 520 patients were initially included
in the study, with a male to female ratio of 1:1
(100:100). A total of 500 patients were con-
sidered for final analysis based on data ade-
quacy. The mean age of the population was
46.3 years, with the minimum age being 20
years and the maximum being 83 years.
Common causes of CKD identified in these
patients included diabetic nephropathy (140,
28%), glomerulonephritis (110, 22%), hyper-
tension (73, 14.6%), tubulo-interstitial disease
(67, 13.4%) and renal stone disease (40, 8%).
The cause was unknown in a significant per-
centage of patients (53, 10.6%). Other causes
including post-partum renal failure, which
constituted 2% of the cases (Table 1).
The majority of patients were in end-stage
renal failure at presentation (93%). Stages 3
and 4 constituted a minority (2% and 5%, res-
pectively) (Table 2). In 20% of the patients, a
diagnosis of acute on CKD, mostly due to
drugs, was made.
A total of 268 patients were below the age of
50 years. The common etiology of CKD in this
age-group included glomerulonephritis (33.2%),
diabetic nephropathy (17.9%), tubulo-inters-
titial disease (10%) and renal stone disease
(13.8%). The patients who had CKD of un-
known cause comprised 12.31%.
Among the 232 patients who were ≥50 years,
the following causes of CKD were identified:
diabetic nephropathy (39.6%), hypertension
(19.8%), renal stone disease (12.9%), tubulo-
interstitial disease (5.6%) and adult polycystic
kidney disease (3%). Only 8.6% of patients in
this age-group had CKD of unknown etiology
(Table 3).
CKD is a worldwide public health issue, the
incidence and prevalence of which are increa-
sing, resulting in high cost and poor out-
comes.1In the United States, the prevalence of
earlier stages of CKD is approximately 100-
times greater than the prevalence of kidney
failure, affecting almost 11% of adults in the
United States.2,3 The situation is probably the
reverse in developing countries, where late
presentation is more common.4
CKD is defined as abnormalities of kidney
structure or function, present for at least three
Table 1. Etiology of chronic kidney disease in the study patients.
Number of subjects
Diabetic nephropathy
Tubulo-interstitial nephritis
Unknown cause
Renal stone disease
Adult polycystic kidney disease
Other causes
Table 2. Stages of chronic kidney disease at presentation.
Acute on chronic
1308 Letter to the Editor
[Downloaded free from on Wednesday, September 28, 2016, IP:]
months,5 and representative estimates of the
burden of CKD in most developing countries
are lacking.3No data regarding the epidemio-
logical pattern have been reported from our
catchment area, and this justifies our study.
It is estimated that the annual incidence of
new cases of end-stage renal disease (ESRD)
is >100 per million population in Pakistan.3,6
In our study, diabetes was the leading cause of
CKD, confirming previous results from Pakis-
tan.4These results are also consistent with
those reported from Western countries. Accor-
ding to the United States Renal Data System
(USRDS), diabetes is the leading cause of
ESRD (42.9%).3The prevalence of diabetes in
countries of the Indian subcontinent is higher
than that reported in Western countries, and is
expected to multiply over the next two
Glomerulonephritis remains the second lea-
ding cause of CKD, which probably reflects
the high prevalence of infections in our
society. Studies from Karachi have reported
chronic glomerulonephritis as the leading
cause of ESRD in dialysis patients, indicating
the high prevalence of infections in the com-
Studies from India have shown that chronic
glomerulonephritis (37%) is the most common
cause of ESRD in their population, followed
by diabetic nephropathy (14%) and chronic
tubulo-interstitial disease.10 Another study from
India reported chronic glomerulonephritis as
the prime cause of CKD (49.4%), followed by
diabetic nephropathy (28.4%).11
Hypertension represents the third major
cause. In our setup, hypertension largely
remains unrecognized and untreated due to the
asymptomatic nature of the disease and lack of
regular health checkup thus leading to com-
plications like CKD.
Tubulo-interstitial disease remains one of the
leading causes (13.4%) in our study, probably
reflecting misuse of analgesics and herbal
In a significant number of patients (10.6%),
the cause of renal failure was not known.
These patients mostly included those who pre-
sented very late or those in whom multiple
disorders co-existed and thus the cause could
not be ascertained.
Limitations of the study
Because of the cross-sectional study design,
the results cannot be generalized to the whole
country. Furthermore, most of the patients pre-
sented with advanced stages of CKD and
biopsy was not possible. The cause was ascer-
tained from the remaining available data, and
this may result in misclassification of etiology
in a few patients.
Conflict of interest: None declared.
Dr. Kifayat Ullah,
Dr. Ghias Butt,
Dr. Imtiaz Masroor,
Dr. Kinza Kanwal,
Dr. Farina Kifayat
Department of Nephrology, Pakistan Institute
of Medical Sciences, Islamabad, Pakistan
Table 3. Age-related prevalence of chronic kidney disease in the study patients.
Age <50 years (total 268)
Age >50 years (total 232)
Diabetic nephropathy
48 (17.9%)
92 (39.6%)
27 (10.07%)
46 (19.8%)
89 (33.20%)
21 (9.05%)
Adult polycystic kidney disease
7 (3%)
Renal stone disease
37 (13.80%)
30 (12.9%)
Tubulo-interstitial disease
27 (10.07%)
13 (5.60)
Unknown cause
33 (12.31%)
20 (8.6%)
7 (2.6%)
3 (1.2%)
Letter to the Editor 1309
[Downloaded free from on Wednesday, September 28, 2016, IP:]
1. Jafar TH. The growing burden of chronic
kidney disease in Pakistan. N Engl J Med
2. Kidney Disease Outcomes Quality Initiative
(K/DOQI). K/DOQI clinical practice guide-
lines on hypertension and antihyper-tensive
agents in chronic kidney disease. Am J Kidney
Dis 2004;43 5 Suppl 1:S1-290.
3. National Kidney Foundation. K/DOQI clinical
practice guidelines for chronic kidney disease:
Evaluation, classification, and stratification.
Am J Kidney Dis 2002; 39 2 Suppl 1:S1-266.
4. US Renal Data System: USRDS. 2000 Annual
Data Report. Bethesda, MD: National Insti-
tutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases; 2000.
5. Rizvi SA, Manzoor K. Causes of chronic renal
failure in Pakistan: A single large center
experience. Saudi J Kidney Dis Transpl
6. Jafar TH, Hatcher J, Chaturvedi N, Levey AS.
Prevalence of reduced estimated GFR (eGFR)
in Indo Asian population. J Am Soc Nephrol
7. Jafar TH, Schmid CH, Levey AS. Serum
creatinine as marker of kidney function in
South Asians: A study of reduced GFR in
adults in Pakistan. J Am Soc Nephrol 2005;16:
8. Rizvi SA, Anwar Naqvi SA. Renal replace-
ment therapy in Pakistan. Saudi J Kidney Dis
Transpl 1996;7:404-8.
9. Kumar H, Alam F, Naqvi SA. Experience of
haemodialysis at the kidney centre. J Pak Med
Assoc 1992;42:234-6.
10. Chugh KS. Renal disease in India. Am J
Kidney Dis 1998;31:Ivii-Iix.
11. Agarwal SK, Dash SC. Spectrum of renal
diseases in Indian adults. J Assoc Physicians
India 2000;48:594-600.
1310 Letter to the Editor
[Downloaded free from on Wednesday, September 28, 2016, IP:]
... 1,2 In Pakistan, CKD is on the rise; due to lack of a national registry to collect data of patients on dialysis. 3 The elevated CKD incidence in Pakistan is considered to be the result of insufficient government support, high rates of diabetes and hypertension, faulty primary health care system and inadequate health education. 3 Chronic dialysis has a great impact on the patients' health-related quality of life (HRQOL), as it affects physical, social, psychological and emotional well-being of patients often leading to anxiety, depression, restless leg syndrome, post-dialysis fatigue and generalized weakness. ...
... 3 The elevated CKD incidence in Pakistan is considered to be the result of insufficient government support, high rates of diabetes and hypertension, faulty primary health care system and inadequate health education. 3 Chronic dialysis has a great impact on the patients' health-related quality of life (HRQOL), as it affects physical, social, psychological and emotional well-being of patients often leading to anxiety, depression, restless leg syndrome, post-dialysis fatigue and generalized weakness. 4 In Pakistan, the QOL in patients with ESRD is assumed to be poorer compared to other countries because only 40% patients can access dialysis service, of which, 67% receive inadequate dialysis (two dialysis/week) and are regarded as under-dialyzed. ...
Full-text available
Background: Hemodialysis is a well-established replacement therapy for patient with end stage kidney disease havin a great impact on the patient’s quality of life. Therefore, the purpose of this study is to identify the health-related quality of life of patients undergoing maintenance hemodialysis. Methods: A cross sectional single centere survey was carried out from March 2018 to June 2018 at Department of Nephrology, Institute of Kidney diseases, Peshawar in Pakistan. A 36 item KDQOL validated Urdu version was used to identify the quality of life of patients. Results: A total of n=184 patients having chronic kidney disease undergoing hemodialysis participated,of whom 63.6% were males and 57.1% patients were Pashtun. A multiple linear regression showed that patients having kidney disease caused due to hypertension had 45% higher kidney disease component summary (KDCS) score while 16% higher physical component summary (PCS) score and 60% higher mental component summary (MCS) score and were statistically significant. Similarly; Peshawari patients had 22% lower PCS score as compared to other ethnic groups ; however, in MCS Peshawari patients had 16% higher score and were statistically significant. Conclusion: The patients have poor quality of life receiving hemodialysis therapy in all three domains like PCS, MCS and KDCS.
... Chronic kidney disease (CKD) is recognized as a major health problem as it is progressive loss of renal function. It is estimated that the annual incidence of new cases of kidney disease (CKD) is >100 per million population in Pakistan (Ullah et al, 2015). The decreased renal function shown by glomerular filtration rate (GFR) of less than 60 mL/min per 1·73 m2, or markers of kidney damage, or both, of at least 3 months duration, regardless of the underlying cause (Thomas et al, 2008). ...
... The number of CKD patients in Pakistan is increasing daily. 21 Adequate treatment and diagnosis will minimise complications and can potentially be lifesaving. The current investigation evaluates the derangement of serum biochemicals including serum electrolytes, glucose, albumin, and renal function biomarkers in CKD patients. ...
Full-text available
Objective Chronic kidney disease and/or disturbance in renal excretory function may lead to nitrogenous waste collection beyond the term as well as derangements of several serum biochemicals. There is no previous study from Pakistan that reveals serum electrolyte derangements in confirmed chronic kidney disease (CKD) patients and other biochemicals associated with CKD. This study aims to examine the derangements of serum biochemicals and the association of several risk factors with CKD. Methods The study enrolled 612 confirmed CKD patients with a glomerular filtration rate (GFR) < 15 ml/min that were treated as a part of the integrated care programme at Mayo Hospital Lahore (one of the largest hospitals in Pakistan). Serum biochemicals were estimated on AU 680 (Beckman Coulter) using the spectrophotometric technique. Results All the CKD patients had elevated creatinine and urea levels, but only 63.4% were suffering from hyperuricemia. The incidence of diabetes and malnutrition assessed by serum albumin (hypoalbuminemia) was 27.4% and 72%, respectively. Among electrolyte disorders, hyperphosphatemia (71.8%) and hypocalcaemia (61.9%) were found to be more prevalent. Furthermore, gender, malnutrition, diabetes, hyperuricemia, and phosphorus and magnesium derangements were found to be statistically significant risk factors for CKD, whereas malnutrition and magnesium derangement were associated with hyperuricemia. Conclusion It is imperative to improve dietary protein and monitor serum electrolyte concentration in renal dysfunction patients to slow the progression of CKD to end-stage renal disease (ESRD) and other serious complications.
... Ashar et al showed a prevalence of 16% in a community-based cohort. 2 On the other hand, in a review of CKD epidemiology in Pakistan it was noted that the prevalence range was from 13% to 30% in different studies. [3][4][5][6] In developing countries like Pakistan, along with the above mentioned causes, kidney stone disease, infections and CKD of unknown aetiology are also major contributing factors for CKD, imposing a persistent threat to kidney health. 7 On the contrary, kidney failure is no more a sequel to kidney stone disease in the Western world, nor is the CKD of unknown aetiology. ...
Full-text available
Chronic Kidney Disease (CKD) is one of the major noncommunicable diseases that have social and economic impacts along with day-to-day health-related problems. Kidney stone disease is still one of the major causes of CKD in Pakistan. Kidney stone disease is a preventable cause of renal failure, if detected and treated early. Kidney stone is prevalent in the stone belt areas in our country which are located in rural areas. The treatment is very costly, and mostly available only in large cities. The treatment requires tertiary care setup and expertise. Therefore, there is a need to focus on the preventive strategies which are mainly dietary and lifestyle modifications, along with public awareness programmes. Nephrologists and urologists along with the government should take interest and give priority to CKD due to stone disease.
... The formation of kidney stones is the most recurrent disease of the urinary system [6] . Chronic kidney disease (CKD) in South Asian countries like Pakistan are on the peak and roughly constitutes 40-50% of the urological workload in major hospitals as the cause of chronic kidney disease (CKD) is multifactorial [7] . Highest prevalence of the renal calculus disease was in the age group 40-49 in males and in the age group 30-39 in females. ...
Full-text available
Urolithiasis is the most common disease of urinary tract found worldwide with approaches for its treatment that include the use of various synthetic and natural drugs or surgery in the conventional system of medicine. This systemic review was taken up to evaluate the efficacy of Berberis vulgaris and Lycopodium clavatum in the treatment of urolithiasis. Total 1471 articles were evaluated and after that 7 articles including case reports and studies were selected for systemic review and results. Total 195 patients were treated in these 7 studies and case reports, 7 patients were treated successfully with Berberis vulgaris. Patients treated with Lycopodium clavatum were 188 and the patients treated successfully were 98 (52.6%). Stone as large as 23 mm was expelled using Lycopodium clavatum. Both these homeopathic remedies showed positive results in treating kidney stones and can be a successful alternative of surgical and non-surgical removal of kidney stones.
... Such cases continue to occur throughout the country, pushing us to draw attention to the issue of Pakistan's rising renal load [1]. Every year, 100 million End-Stage Renal Disease (ESRD) patients are diagnosed in Pakistan as a result of inadequate and poor primary healthcare facilities, late diagnosis, and comorbidities such as hypertension and Diabetes Mellitus [2]. In Pakistan, peritoneal or hemodialysis is the most frequently opted therapy, as opposed to the ''gold'' standard aspect of renal replacement therapy (RRT) in terms of renal transplantation used internationally, which, while expensive, promises well-being and an increase in life expectancy of eight to twenty years [3]. ...
Owing to inadequate healthcare facilities in Pakistan, millions of patients are diagnosed with end-stage renal disease. Dialysis is the frequently opted therapy instead of the recommended renal transplant, which promises a longer life expectancy. This stems from Pakistan’s Transplant Law which only allows blood relatives to donate altruistically. With ineffective legislation, transplant tourism has been on the rise again. Unauthorized agencies extort vast sums of money from putative recipients while jeopardizing the lives of underprivileged individuals through mismatched HLA typing and surgical site infections in makeshift ORs. This study explores the difficulties Pakistan faces in increasing the donor pool. These range from an ineffective deceased donor program. Communal ties overrule the potential donor’s willingness while additionally receive criticism from religious communities. Efforts by the Pakistani government seem insufficient to cater to the growing populace of chronic kidney diseases. This study further assesses the existing methods used worldwide to bridge the gap between the donor pool and the recipient list, including the Iranian Model of unrelated kidney donor programs and organ-preserving ICUs to facilitate the deceased donor program from the road fatalities.
... Overall, it is shown that GANAB mutations cause ADPKD and that the cystogenesis is most likely driven by defects in PC1 maturation (Table 2). 14 The structures of these encoded proteins have been predicted with the assistance of gene mapping and molecular applications and even the DNA sequencing has also been done of PKD1 and PKD2. 10,15 These are membrane proteins 16,17 ; located mostly on hair like surface structures [16][17][18] termed as primary cilium 16,19 ; anchored with the help of basal body in to the cell body of most mammalian cells. ...
Full-text available
Objective: To document overall adherence to haemodialysis, medications, fluid restriction and dietary prescription in patients with end-stage renal disease and to study factors that could predict poor adherence. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi, from Jul to Sep 2018. Methodology: Adult patients on haemodialysis for at least three months were selected using consecutive sampling technique. Patients with acute kidney injury, patients on haemodialysis for less than 3 months, those on infrequent haemodialysis and unwilling patients were excluded. Demographic data was recorded. Adherence to management was assessed by administering End Stage Renal Disease Adherence Questionnaire in direct face- to-face interviews. Results: There were a total of 101 patients having a mean age of 51.05 ± 13.80 years. Median haemodialysis vintage was 9 months (interquartile range 3-24 months). Mean adherence scores were 970.54 ± 149.43. Mean perception scores were 7.22 ± 1.37. Only 49 (48.51%) patients had good adherence, whereas 52 (51.49%) had poor adherence to management. Increasing age was associated with poor adherence (β=-0.038; Odds Ratio=0.963, 95% CI 0.928- 1.000, p=0.048). No other demographic parameter could predict poor adherence. Conclusion: Non-adherence to different aspects of management plan was a significant problem, more so in younger patients.
Full-text available
Objective: To determine the pattern of histopathology in living-related, kidney transplant recipients (KTRs) from a transplant centre in Khyber Pakhtunkhwa (KPK), Pakistan. Study design: Descriptive, observational study. Place and duration of study: Institute of Kidney Diseases, Peshawar, from August 2008 to July 2018. Methodology: A retrospective review of graft biopsy reports and clinical charts from living-related, kidney transplant recipients was carried out. Allograft biopsies were done for graft dysfunction with no apparent cause. The biopsy pathology was classified according to updated Banff classifications. The descriptive statistics were used to tabulate the results. Results: Out of the 55 biopsies, 51 (92.73%) were from males with mean age of 34.35±9.40 years. Out of 52 percutaneous biopsies, 10 (19.23%) belonged to the normal category. Category 2 (borderline rejection) and 3 (acute/active cellular rejection) were seen in three (5.7%) and one (1.9%) cases, respectively. Interstitial fibrosis/tubular atrophy (Banff Category 5) was observed in 18 (34.62%) cases. Banff Category 6 (others) was seen in 19 (36.5%) cases, in which calcineurin inhibitors (CNI) toxicity was commonest (17 [89.4%] of 19 cases). Mixed lesions were found in 19 (36.5%) cases. Out of the 19 mixed category cases, 12 (63.16%) showed both Category 3 and Category 5 changes with most of the cases showing mild to moderate IF/TA; while one case had severe IF/TA. Three graft nephrectomies were done, one each for recurrent oxalosis, nephroblastoma and fungal infection. Conclusion: Among the studied specimens, mixed lesions were the predominant findings, followed by others (mostly CNI toxicity) and IFTA categories. The frequency of acute/active rejections was low and that of chronic changes higher, in keeping with delayed biopsies. Key Words: Allograft biopsy, Graft dysfunction, Rejection, Kidney.
Full-text available
Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged > or = 40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of <60 ml/min per 1.73 m2. Creatinine excretion was compared with age- and gender-matched white individuals by comparison of observed versus expected results on the basis of a formula using t test. The agreement among Cockcroft Gault (CG) Ccr and Modification of Diet in Renal Disease (MDRD) Study GFR equations was assessed by regression analyses, and the degree of accuracy of estimated versus measured GFR was determined. Mean (95% confidence interval) creatinine excretion was 1.7 (1.0 to 2.4) mg/kg per d lower than expected for age- and gender-matched white individuals (P < 0.001). The coefficient of determination for measured Ccr on the logarithmic scale was 66.7 and 55.6% for the CG and MDRD Study equations, respectively. The proportion of estimates within 20, 30, and 50% of measured Ccr values was 47.7 versus 32.8% (P < 0.001), 64.9 versus 49.6% (P < 0.001), and 79.4 versus 72.9 (P = 0.07) for CG versus MDRD Study equations, respectively. Lower mean creatinine excretion in these individuals may explain, in part, suboptimal agreement between estimated versus measured GFR. Inclusion of terms for ethnic and racial groups other than white and black might improve the performance of GFR estimating equations.
Seventy-nine patients of end stage renal disease (ESRD) on maintenance haemodialysis were studied. Most of the cases were in their prime of life. The disease was equally common in both sexes and all ethnic groups. Chronic glomerulonephritis was the commonest cause followed by diabetes mellitus. Hypertension was the commonest associated illness. All patients were screened for hepatitis B surface antigen and antibody and those found negative were vaccinated. A-V fistula in the upper extremity was used as the vascular access in 93% cases. In 68% cases dialyzer was reused without any ill effect. Amongst the complications observed, hypotension was seen in 65%, psychological disorders in 52%, followed by nausea, vomiting, itching and cramps. Technical complications were related to A-V fistula in 45% cases. Forty three percent patients were maintained without blood transfusion and 88% showed improvement in their quality of life.
Inspite of nephrology as a specialty since seventies, there is still paucity of data regarding the spectrum of renal diseases in India. Available literature from few hospitals shows data on specific clinical syndrome of renal diseases or specific renal diseases rather than the overall spectrum as a whole. This information will be useful for better resource management. We studied spectrum of renal diseases among 14,796 patients presenting for the first time to nephrology outpatients between January 1987 to Oct. 1998. Majority of patients in our clinic were adults. Patients 14 years or below who mostly attend pediatric renal unit of the hospital were excluded from the analysis. Till 1991, the study was retrospective but after 1991, patients were followed prospectively. Patients were grouped according to classical renal syndrome. After the initial presentation, patients were followed subsequently till their last follow-up in the clinic or till the time of reporting the present data. Mean age of patients was 38.69 +/- 15.5 years with male predominance in majority of presentations. Chronic renal failure (CRF), nephrotic syndrome (NS), nephritic syndrome and hypertension were the four common presentations seen in 47.8%, 15.03%, 4.6% and 4.9% cases respectively. Other presentations were acute renal failure (1.9%), urinary tract infection (2.9%), stone disease (4.6%), obstructive uropathy (2.1%), isolated haematuria (1.2%) and asymptomatic urinary abnormalities (0.3%). Chronic glomerulonephritis was seen in 49.4% cases of CRF followed by diabetic nephropathy in 28.4% cases. Of the nephrotic syndrome cases, primary glomerulonephritis was seen 58.5% cases, of which minimal change disease was the commonest cause in 38% cases. Of the secondary glomerular diseases, diabetic nephropathy was commonest cause of NS (53%) followed by amyloidosis (16.4%) and lupus (8.3%). Tuberculosis was the commonest cause of renal amyloidosis seen in 50% cases. Of the nephritic syndrome, post-infective glomerulonephritis was commonest cause followed by rapidly progressive glomerulonephritis being the second commonest cause. In the hypertensive group, essential hypertension was the commonest cause followed by renovascular hypertension. It is the first large study of its kind presenting the spectrum of renal diseases in the tertiary-care government hospital of the country and we expect the disease pattern to be reasonably similar in other similar government hospital of the country. Chronic renal failure, nephrotic syndrome and diabetes are three major diseases, with which we have to deal maximum. As CRF in young male patients is the largest load, with its wide social and economical implications in the Indian context, we must gear up to organise ourselves for providing the best possible care to these patients with the limited resources.
Many developing countries are facing a silent epidemic of chronic kidney disease — one facet of the health transition associated with industrialization. Dr. Tazeen Jafar writes that data from community-based studies reveal an alarmingly high burden of chronic kidney disease in Pakistan.
Prevalence of reduced estimated GFR (eGFR) in Indo Asian population
  • T H Jafar
  • J Hatcher
  • N Chaturvedi
  • A S Levey
Jafar TH, Hatcher J, Chaturvedi N, Levey AS. Prevalence of reduced estimated GFR (eGFR) in Indo Asian population. J Am Soc Nephrol 2005;16:323A.
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihyper-tensive agents in chronic kidney disease
Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihyper-tensive agents in chronic kidney disease. Am J Kidney Dis 2004;43 5 Suppl 1:S1-290.