Present, Past and future of Paediatric –Nephrology in Kanti Children’s Hospital
Kanti Children’s Hospital is the only tertiary care government’s hospital in the country dedicated exclusively to Paediatric services. Paediatric population up to 15years of age comprises about 45% of population in Nepal. Paediatric patients are mainly treated by health workers in community level and medical doctors and paediatricians in regional and central level .As a only tertiary care government’s hospital, many different types of diseases from different parts of the country are referred to Kanti Children’s Hospital for treatment. Due to lack of facilities in the country, many serious and chronic cases is referred to abroad for treatment.
Health services need to be developed in preventive, promotive and curative manner. However not only quantitative but also qualitative services should be provided to the needy people. Governments and non governmental hospitals, private nursing homes, medical college hospitals and diagnostic centers provide curative services in urban areas, while primary health care centers, health post and sub health posts provide them in rural areas. Curative services are provided at primary, secondary and tertiary levels. Kanti Children’s Hospital .BP Koirala institute of health sciences, some private Nursing homes and some medical college hospitals offer tertiary care for children. Tertiary care in private nursing homes and medical college is quite expensive and not affordable to general populations.
One of the government’s priorities is to strengthen curative services in the central level hospitals in the country. This needs specialized and super specialized services to be developed in these hospitals. Need of such sub –specialty units in tertiary care hospitals like Kanti Children’s Hospital is beyond doubt. In 2058 Jestha, Paediatric nephrology sub- speciality unit was established in Kanti Children’s Hospital with the initiation of the then Chief Consultant Paediatrician Dr. R. M. Shrestha. This unit was initially run by Dr. R. M. Shrestha, Dr. K.P.Bista (Who was trained in Paediatric Nephrology in Israel) and Dr. F.C. Gami (Now Professor of Paediatrics in TU Teaching Hospital).
Paediatric nephrology is a relatively young and emerging sub-speciality in developing countries like Nepal. Before the advent of renal replacement therapy (dialysis and renal transplant} there was very little interest in nephrology. Following dialysis and renal transplant, the quality of life of patients with chronic renal failure has been improved with long survival period. Kidney diseases are quite common in Paediatric population. Children with kidney diseases whether acute or chronic in nature should be followed up regularly. Different studies show that 2% of the total admission in Paediatric medial wards is due to kidney problems. Total number of renal problems in Paediatric OPD is difficult to calculate as they are seen by different doctors and OPD records are not always updated. Due to sophisticated instruments and expert radiologists significant no. of congenital renal problems such hydronephrosis, renal cysts, obstruction in renal tracts etc are diagnosed in intrauterine life and treated accordingly.
From Jestha 2058 Paediatric Nephro-OPD runs once in a week on Friday from 11.00 A.M. to 1.00 P.M. We have made Performa for Nephro-OPD and completed when new patients come to OPD. Separate No. is given for each patients and separate file is maintained. 8 separate beds are allocated for Nephrology in 2059 Asoj in medical wards. Now there is significant improvement in laboratory facilities and radiological investigations in hospitals and private facilities. serum urea, serum creatinine, serum sodium, serum potassium and urine routine tests are available for 24 hours. Radiological investigations such as ultrasound, micturating cystourethrogram, intravenous urography and computerized tomography help diagnose diseases accurately and easily.
Trained paediatricians and nurses in Paediatric nephrology is always a problem. After separate OPD and wards one of our senior consultant Paediatrician Dr .Shiva Kumar Shrestha got training in Paediatric nephrology and run nephro-OPD and indoor ward for few years. Now Paediatric –OPD is run by consultant Paediatrician Dr. Krishna Prasad Bista and Paediatrician Dr. Najala Khatun. Paediatric indoor is run by Chief Consultant Paediatrician Dr. Binod Man Shrestha and consultant Paediatrician Dr. Krishna Prasad Bista for last 2 years. Peritoneal dialysis and Kidney biopsies are done occasionally.
Paediatric nephrology is relatively young sub-speciality and there are very few trained paediatricians and nurses in Nepal. So government should take initiation to develop trained man powers. Separate set of doctors and nurses should be developed to run the nephrology unit in full fledge manner. Only 8 beds in medical wards are not sufficient so there should be separate wards with 20 beds along with one peritoneal dialysis room for 2 patients. Laboratory tests such as ANA, Ds DNA, Complement assessment etc which is very expensive and not available in hospital should be started in hospital. There is no haemodialysis machines in hospitals and peritoneal dialysis are not done regularly in hospital. Regular peritoneal dialysis and haemodialysis should be started as soon as possible Paediatric nephrology –OPD should run 2 days in a week.
Dr. K.P.Bista, Dr. S. K. Shrestha Dr. B.M.Shrestha Dr.N.Khatun