The study was carried out at Paediatric Nephrology division of the Department of Paediatrics, G.B. Hospital, Govt. Medical College Srinagar. It is one of the tertiary hospitals in the state providing Paediatric nephrology care to children of Jammu and Kashmir, India. During the study period only peritoneal dialysis services were utilized and those patients needing haemodialysis and renal tranplant were referred to advanced centers of the country. Retrospective data of all children, aged between 0-18 years, admitted over a period of one year (2012-2013), was analysed statistically using the Statistical Package for Social Science software version 18.0. This included the demographic data, clinical history, investigations, diagnosis, disease outcome and procedures such as dialysis and renal biopsies. Detailed history, thorough clinical examination and relevant laboratory investigations including imaging, immunologic and histopathologic studies helped us in making the diagnoses. Imaging techniques such as ultrasonography, micturating cystourethrogram, intravenous urogram, computerized tomography and magnetic resonance imaging were also employed. AKI was diagnosed using the RIFLE (Risk, Injury, Failure, Loss, End-stage) criteria [2]. Chronic Kidney Disease (CKD) and nephrotic syndrome were defined based on the Kidney Disease Outcomes Qualitative Initiative (KDOQI) [3].

Total number of patients admitted during the study period was 28114. Among these patients 447 were having renal and urinary tract derangements. Out of these 447 patients, male were 215 and females were 232. Six to twelve years age was the most common age group having renal problems. Acute kidney injury was the commonest entity (32%), seconded by the UTI (24%). There was a significant correlation between the pattern of renal disease and the age of presentation (p <0.05); 80% of patients with glomerular diseases were between 4-12 years of age, whereas 90% of those with congenital renal anomalies were below 4 years of age. Pertaining to gender, UTI was more common in females (p <0.05). Other findings are depicted in [Table/Fig-1].

The prevalence of 1.58% for kidney disease among hospital admissions is similar to the previous reports [4,5] which range from 1.1–4.5%. However, a study from Nigeria reported a prevalence of 8.9% [6] and prevalence of 12% was reported among Paediatric admissions from a tertiary center in our country [7]. This may be indicative of poor disease characterization, consequent upon relative under-development of the sub-specialty in the state of Jammu and Kashmir. Studies from the United Kingdom and America are largely centered around chronic kidney disease, presumably due to significant advancements in the provision of Renal Replacement Therapy (RRT). AKI was our leading diagnosis which is contrary to the studies from other parts of the world [8,9]. Higher diagnostic rate of AKI in our study could be result of use of the RIFLE criteria, which enables the inclusion of earlier stages of AKI [10]. However, UTI were the next common disorders which is in conformity with the earlier studies [11,12], We observed Acute Nephritic Syndrome (ANS), at rate of 9.6% of total paediatric nephrology disorders which is very low in contrast with reports from different countries showing higher prevalence rates of AGN; China (30%), Nigeria (37.7%), and South Africa (45%) [13–15]. This difference could be because of environmental, racial, and genetic factors and a low referral rate to our centre. Among the renal and urological disorders 4% were the CAKUT, among which renal hypoplasia, dysplasia, multicystic dysplastic kidney, hydronephrosis, ureteropelvic junction obstruction, and vesicoureteral reflux were the common ones. In our study, 13 children (2.9%) had CKD which is comparable to other studies [14,16], while as higher figures were reported from other developing countries; Nigeria (20.3%), Iran (14.9%), and Jordon (17.3%) [13,15,17].

Limitations of our study is its retrospective nature, less advanced Paediatric nephrology center, and exclusion of incomplete records. The prevalence reported in this study may therefore be an under-estimation.

We observed that a substantial number of children are hospitalized with renal and urinary tract diseases with delayed ages of presentation, which could be prevented or treated if timely diagnosed. Our study implies that majority of these ailments are treatable and highlights the need for heightened awareness about these ailments and development of a comprehensive service for the children with renal and urinary tract diseases in J&K India.