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Regional variation of underlying kidney diseases in children undergoing chronic kidney replacement therapy around the
Dagmara Borzych-Dużałka1, Marjolein Bonthuis2,3, Uma Ali4
1Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland. dagab@gumed.edu.pl.
Insights
Global kidney failure causes in children vary significantly by region and economic factors. Immune-mediated diseases are common in low-income countries, while hereditary conditions prevail in others, impacting pediatric kidney replacement therapy.
Area of Science:
- Pediatric Nephrology
- Global Health
- Epidemiology
Background:
- Limited data exists on pediatric kidney failure (KF) causes in developing nations.
- Registry data offers a global perspective on the disease spectrum in children undergoing kidney replacement therapy (KRT).
Purpose of the Study:
- To analyze the global distribution of diseases causing kidney failure in children.
- To identify regional variations and influencing factors in pediatric kidney failure etiologies.
Main Methods:
- Analysis of KF causes in 23,620 children and adolescents starting KRT across 80 countries.
- Data sourced from IPNA Global KRT Registry, IPDN, USRDS, and ANZDATA.
- Consideration of geographic region, GNI, temperature, and patient age.
Main Results:
- Significant regional differences in KF causes: immune-mediated glomerulopathies (GP) in Southeast Asia, hereditary nephropathies in the Middle East/Africa/Europe, systemic GP in Northeast Asia/Latin America.
- 14% of KF causes were unknown, highest in Northeast Asia.
- Low GNI and warmer climates correlated with higher rates of immune-mediated GP. Congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies were more common in younger children, while immune-mediated GP predominated in adolescents.
Conclusions:
- Global pediatric kidney failure causes exhibit substantial variability.
- Genetic, environmental, and macroeconomic factors contribute to these observed differences.
Background:
There is a scarcity of information regarding the distribution of the diseases leading to kidney failure (KF) in children living in the emerging world. We used registry data to provide a global overview of the underlying disease spectrum in children commencing kidney replacement therapy (KRT).
Methods:
We analyzed KF causes among 23,620 children and adolescents commencing maintenance KRT in 80 countries, using data from the IPNA Global KRT Registry (including ESPN/ERA Registry), the International Pediatric Dialysis Network (IPDN), the United States Renal Data System (USRDS), and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The analysis considered geographic region, country-level gross national income (GNI), average annual temperature, and patient age.
Results:
Marked regional differences were observed in the distribution of KF causes. Immune-mediated glomerulopathies (GP) were most common in Southeast Asia, hereditary nephropathies in the Middle East, Africa, and Europe, and systemic GP in Northeast Asia and Latin America. In 14% of cases the cause of KF was unknown, with the highest proportion in Northeast Asia. Disease patterns were also influenced by countries' GNI and average yearly temperature; immune-mediated GP accounted for 43% of diagnoses in low-income countries and were more frequent in warmer climates. Among younger children, congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies were the predominant cause of KF, whereas adolescents more commonly presented with immune-mediated GP.
Conclusion:
There is significant global variability in the spectrum of diseases leading to pediatric KF, partially attributable to genetic, environmental, and macroeconomic factors.
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