36. Diseases of the Kidney and the Urinary System

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Abstract

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Diseases of the kidney and urinary tract rank 12th among causes of death worldwide and 17th among causes of disability, and incidences of kidney disease and kidney failure are rising fastest in developing countries. Efforts to reduce the burden of end–stage renal disease (ESRD), such as renal replacement therapy (RRT) and hemodialysis, are becoming increasingly expensive or require costly ongoing interventions that render them unsuitable for developing countries that lack equipment, trained staff, and health insurance.

In the developing world?especially in low–income countries and tropical regions?kidney disease often takes the form of glomerulonephritis, and can also result from infectious diseases such as malaria and hepatitis B virus. Meanwhile, tuberculosis?a major killer in developing countries?can cause secondary urinary and kidney complications, including lesions that ultimately destroy the kidney. Malnutrition, among other factors, can lead to both bladder stones and kidney stones, which, left untreated, can progress to ESRD. Overall, the incidence of ESRD is increasing worldwide at a rate more than six times that of the annual population growth.

The prevalence of ESRD means that more people require kidney transplants, but a large proportion of people living in the poorest countries die for lack of access to RRT. Improving the standard of living in developing countries is one step in combating diseases of the kidney and urinary system because poverty is associated with increased exposure to infectious diseases that increase susceptibility to chronic kidney disease. In this part of the world, the most cost–effective option is prevention?including screening relatives of ESRD patients, changing dietary habits, and administering blood pressure–reducing agents. Developing countries also need financial support to develop centers of excellence focusing on preventing kidney and urological diseases and improving care for renal failure.