Call for early detection of children's kidney problems

JAKARTA (JP): Indonesia needs an early detection system for kidney problems in children and an integrated medical program for doctors, an expert in child nephrology said yesterday.

Husein Alatas, in his inauguration as professor at the University of Indonesia's Medical Faculty, said that both measures were more cost effective than the high price of treatment for patients with advanced kidney problems.

Husein said that primary prevention would help stop healthy children becoming ill and early and adequate treatment could overcome kidney problems in children. He said this could happen at public health centers and mother-child clinics.

He said kidney treatment was too expensive for most Indonesians. Dialysis for children cost Rp 250,000 (US$96.15) weekly, usually requiring two hospital visits.

Treatment could cost a young dialysis patient Rp 2 million ($770) a month, while those having Continuous Ambulatory Peritoneal Dialysis (CAPD) could have to pay Rp 1.5 million ($576.92) a month, he said.

He said CAPD referred to a portable dialysis technique, developed in 1976 by R.P. Popovich, which allowed a child with chronic kidney failure to perform dialysis five times daily, every four hours, with the help of a trained parent.

This dialysis technique enabled affected children to pursue their schooling and other activities, he said.

He said a kidney transplant, from the donor transplant to administering medication, cost Rp 20 million ($7,600).

Husein cited a long-term study of 30 children that showed that children who had kidney transplants more than 10 years ago could lead productive lives.

He said that 86 percent of the recipients were in good or very good health, 43 percent were married and 77 percent either worked, studied or did not work to care for their children.

Another report found that 70 percent were employed or working independently, he said.

The quality of life for recipients increased in the long term and they became productive workers, he said.

He said at a press conference that Indonesia would have to compete with foreign doctors experienced in nephrology and deal with a shortage of local medical specialists who knew about nephrology, including for children.

Husein said there were still kidney transplant problems in Indonesia because patients could not afford treatment or they could not continue to rely on live kidney donors, which left a child with the limited option of securing kidneys from parents or other relatives.

He said transplanting kidneys from dead donors had not been successful because of strong public opinion against surgery on corpses, despite religious leaders' acceptance in 1995 of the idea of transplanting kidneys from live and dead donors.

Law No. 23 of the 1992 Health Law allowed kidney transplants from dead donors, but commercial organ donation was not allowed and was illegal here but not in other countries, he said.

Kidney transplants in Indonesia had been performed on 227 adults since 1977, he said.

He cited a four-year-old study which ended in 1995 that showed that 6.2 percent of children admitted to the state-owned Cipto Mangunkusumo hospital were kidney patients, or 688 of the 11,162 children treated at the hospital. Kidney and urinary tract problems were the leading kidney problems affecting children, he said. (01)