Chronic kidney disease: the ABC of nephrology.

1 Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and Shaw-NKF-Children’s Kidney Centre, The Children’s Medical Institute, National University Hospital, Singapore Address for Correspondence: Dr Yap Hui Kim, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge, Singapore 119074. To this day, in many parts of Asia, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. With improvements in public health, many countries have seen a decrease in infant mortality rates, with a shift in the causes of mortality from infections to other chronic diseases such as malignancies. This is especially significant in the adult population, which has seen a rise in the prevalence of “lifestyle” diseases such as obesity, hypertension and diabetes, resulting in increased morbidity due to cardiovascular and cerebrovascular complications as well as chronic renal failure (CRF). In fact, the incidence of endstage renal disease (ESRD) is increasing worldwide, ranging from 75 to 350 per million population in developed countries.1 Over the last decade, the number of patients on renal replacement therapy has more than doubled in many countries. The prevalence of ESRD is a good indicator of the burden of renal diseases, as most chronic nephropathies progress relentlessly to ESRD. In the adult population, the increased prevalence of chronic kidney disease (CKD) is due primarily to the increasing incidence of diabetic nephropathy, not only in the USA and Europe, but also in our Asian populations such as Singapore and Malaysia.2 Consequent upon this high incidence of ESRD, an estimated 349,911 patients were on dialysis in Asia at the end of 2004.1 On the other hand, the incidence of ESRD in children worldwide ranges from 3 to 15.5 per million population under the age of 19 years,1 without the marked increases seen in the adult population. Should paediatricians then be concerned about this worldwide epidemic of ESRD in adults? In the words of James Joyce, one of the most significant writers of the 20th century: “I am tomorrow, or some future day, what I establish today. I am today what I established yesterday or some previous day...”, how we care for the child of today, will impact on his well-being tomorrow when he has grown into an adult. Therefore, pari passu with the strides taken in improving infant and child health over the last decade, paediatricians should look beyond treating the child today, but instead focus on treating the child as the future adult. In other words, when one looks at the problem of ESRD, this is the final event of a sequence Chronic Kidney Disease: The ABC of Nephrology Hui-Kim Yap,1MMed (Paeds), MD, FAMS