The young and their kidneys
As a pediatric nephrologist, it’s painful to be treating a child as young as seven years old for chronic kidney disease [CKD]. This could have been prevented if intervention was done earlier.”
Her words brought on vivid memories. One was of a man who I would occasionally bump into in the parking area whenever I would do the rounds trying to look for a parking space. He drove a white utility vehicle which had a makeshift sign that said, “Dialysis patient on board.” His child required treatment thrice a week, and they would travel all the way from the uplands of Cavite, making sure to leave in the early hours of the morning in order to make it to their scheduled session.
The other one was of a guard who worked in the building where a sibling of mine lives. Years back, he had told me that he had seen me in the hospital when he took his child, who also had a renal condition, for a consult. They were under the care of a private specialist because they didn’t have the time to wait in line for social services, as his wife was also working. With a pained smile, he shared that the cost of the maintenance medications was getting to be too prohibitive. Hoping to provide a solution, I looked into it, but learned that there were no generic alternatives in the market. On occasions when I would chance upon him manning the open guard house in the rain, I couldn’t help but wonder how they managed to cope.
The last memory was of a boy I met during my early years in practice under the flyover of the intersection between Edsa and Kamias. I would usually see him on my way home from work on Saturdays, selling sampaguitas. From our first meeting, I learned that he attended school during weekdays, and from then on, when the traffic lights would permit, we would have quick exchanges on how he was doing. He had the look of someone with a renal condition. His sister later confirmed this after I had missed seeing him for weeks.
CKD affects both adults and children. CKD can result in end-stage renal failure, which unfortunately is irreversible. From the situationer provided by our pediatric nephrology colleague, “PhilHealth spent a total of P36.04 billion on hemodialysis alone in 2025, which is more than double the figure from 2023. Hemodialysis now consumes roughly 12 percent of total PhilHealth claims payments and up to 25 percent of total national health expenditures. The estimated total annual cost of CKD management in the Philippines, including direct standard care, complications, and indirect out-of-pocket costs, stands at P592.15 billion.”
From the pediatric end, she also shared that “the current national prevalence for chronic kidney disease in children is at 11.2 percent. In the National Kidney and Transplant Institute pediatric CKD cases have doubled from 2023 to 2024.”
Thinking that these numbers were largely due to the complications of recurrent infection, or from risk factors such as obesity, hypertension, and uncontrolled diabetes in adults, I was surprised to learn that the main drivers were actually congenital anomalies of the kidneys and the urinary tract, aptly termed CAKUT. Globally, around 40–50 percent of CKD is attributed to CAKUT.
So how can we help as pediatricians or general practitioners? Currently, there are only 160 pediatric nephrologists nationwide. Given this limited number, what we can do is improve our network to identify the available specialists in our area once we encounter children or even infants with the red flags of CAKUT, namely: recurrent urinary infections, failure to thrive, prenatal anomalies, or poor urinary stream in newborn males. We need to heighten our index of suspicion as there is that real possibility that we might miss it and attribute it to other causes. On the subject of recurrent urinary tract infections, more often than not, this is treated as an isolated infection rather than a signal to investigate the underlying cause. In patients who fail to thrive, this may be initially regarded as a nutritional or gastrointestinal concern, and for newborns with a poor urinary stream, a benign variation. We need to push for further workup and diagnostic evaluation so intervention may be given at the earliest possible time, to prevent progression of the disease before it becomes irreversible and necessitates a kidney transplant.
While I may have been very pointed about CAKUT, as a whole, we all need to be reminded about taking good care of our children’s kidneys by starting them early on a proper diet. Avoid giving them processed food, and regulate salt and sugar intake, which can lead to obesity and make the kidneys work harder. Encourage hydration and physical activity.
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timgim_67@yahoo.com
