As the world observes World Kidney day, it is shocking to know that upto 80 percent of critically ill newborns in our country suffer from Acute Kidney Injury (AKI), commonly known as Acute Renal Failure.

As many as 30 - 50 % of patients in the ICU and about 5% of hospitalized children overall have this condition.

Again, Chronic Kidney disease (CKD) together with End stage renal disease (ESRD) has a worldwide incidence of 75 - 350/million population.

Approx. 3,00,000 ESRD children exist in India with fewer than 5% receiving renal replacement therapy.

Acute Kidney Injury (AKI) is commonly precipitated by -Acute Gastro Enteritis, blood loss, shock, inflammation of the Liver (Known as Fulminant Hepatitis), heart failure etc. In this background, assessing Kidney function precisely assumes particular significance.

Early detection of a functional abnormality leading to a prompt intervention can prevent significant kidney damage. Unfortunately, as of now we don't have many diagnostic methods or tests in place, which could help us detect these abnormalities early especially before the disease has become clinically manifest.

Kidney function so far is gauged by creatinine & its small rise increases risk of mortality. Creatinine tends to be an unreliable indicator of AKI (Variations with age, gender, muscle mass & metabolism, hydration status) & does not change until 50% of Kidney function is lost.

In the near future there would be novel biomarkers for early detection & management of kidney injury including Urine panel of NGAL, IL-18, KIM-1, & Plasma panel of NGAL & cystatin C. These biomarkers are sensitive much before rise in Sr. creatinine.

Various drugs & agents including painkillers & anti-inflammatory drugs, antibiotics, herbal & alternative medicines also cause kidney injury.

The Symptoms & Signs are often Subtle & hidden! Laboratory investigations include detailed blood and urine analysis with radio imaging. Management of AKI (Accute Kidney Injury) is treating the basic causes, management of complications e.g. Fluid overload, Hypertension, etc. Occasionally dialysis is required to sustain kidney function.

Urinary Tract Infection (UTI) is a common cause of chronic kidney damage. 150 million people per year become infected. 5% of general practitioner visits are for UTIs. Prevalence - In girls <1 year is 6.5%, boys is 3.3%, in girls >1 year is 8.1%, boys is 1.9%, <1 year, uncircumcised boys have a 10 fold increase in risk.

Urinary Stone Disease: "Renal stone disease in children is not uncommon, and can present in classical or atypical manner. It is more common in children < 5 years, with 90% of infective causes. Stones have to be removed; Antibiotics are an important treatment modality. The Long-term outcome is Good, with < 10% recurrence. A metabolic cause can be identified in 50% of the cases", says Dr. P.P. Singh, Sr. Consultant Urologist, Batra Hospital.

Overall, formulating strategies for controlling CKD is of the utmost importance. Control of CKD is with managing fluid electrolyte disturbances, hypertension, protein in urine, obstructive changes etc., Medication for hypertension, control blood sugar levels in diabetics, lifestyle changes especially in adolescents, including physical exercise, avoiding smoking and alcohol intake, restricting sodium intake etc. are all important. CKD must be detected early, regular screening of children in "at risk" category & Nation wide school screening programmes are crucial for detection of Proteineuria, Haematuria, Hypertension etc.