Social Marginalization, A Problem in Controlling Childhood Chronic Kidney Disease

Special Article - Chronic Kidney Disease

Austin J Nephrol Hypertens. 2015;2(1): 1033.

Social Marginalization, A Problem in Controlling Childhood Chronic Kidney Disease

Medina-Escobedo Martha* and Martín-Soberanis Gloria

Research Unit Kidney Diseases, General Hospital “ Dr Augustine O’Horán “ Health Services Yucatán

*Corresponding author: Martha Medina- Escobedo, Hospital General O’Horán, Av. Itzáez por Jacinto Canek S/N, Col. Centro, C.P. 97000, Mérida, Yucatán, México

Received: December 12, 2014; Accepted: February 02, 2015; Published: February 04, 2015


We report here the case of a 14-year-old male patient previously treated for a bilateral obstructive uropathy secondary to a urinary lithiasis and the associated urinary infection. Upon hospital admission, he was diagnosed with undernourishment, chronic renal failure, urinary infection, an endoparasitic disease (ascariasis) and sepsis. After clinical and surgical treatment the patient´s condition improved. The patient has been monitored over the course of seven years and this revealed a gradual deterioration due to a combination of factors: social marginalization, family illiteracy, irregular adherence to treatment, poor attendance of medical appointments, and incomplete health coverage (Seguro Popular).

Keywords: Chronic kidney disease; Urinary lithiasis; Social marginalization; Children


Chronic kidney disease (CKD) is a serious problem worldwide, with an increasing incidence. Whereas diabetes mellitus is the main driver of CKD in adults [1], at pediatric ages it is usually derived by obstructions of the urinary system due to malformations, although urinary lithiasis may also cause of this condition, albeit with a lower frequency. Other factors such as glomerulopathies, urinary infections (although not as a main driver) and social marginalization (SM) can also contribute to the progression of kidney damage [2-5]. This report aims to present the clinical case of a patient in whom several risk factors, and most notably social marginalization, converge in the development of CKD.

Case Study

The subject of this study is 14-year-old male patient (ACU) who is original from Tepakan (Yucatán, Mexico). He comes from a large and illiterate family, with a low income and poor socio-economic background. They live in a humble home in sub-standard conditions due to the lack of basic sewage and sanitary services. Communication with the mother is difficult, even with the aid of a Mayan translator.

ACU has a history of urinary infection (UI) in pre-school years and he was admitted to hospital when he was 6 years and 9 months old with a rapidly evolving clinical condition characterized by anorexia, nausea, vomiting, fever, pyuria and generally poor conditions: dirty, with lice, a mycosis in the genital region and both feet, as well as symptoms of sepsis. Upon admission, he weighed 10 Kg and measured 82 cm in height, and he was registered with the Social Security (Seguro Popular), a social security scheme for a population without rights to other types of medical insurance.

Laboratory tests and medical examination identified showed retention of nitrogenous components in the blood (urea 445 mg/ dl and creatinine 7.3 mg/dl), hyperuricemia (8.7 mg/dl), anemia (Hb 6.77 gr/dl) and leukocytosis (29,400/mm3)). A coproparasite study identified Ascaris lumbricoides (roundworm) and the blood culture was positive for Pseudomona aeruginosa. Ultrasound studies identified urinary lithiasis (left ureter 5 mm and bladder lithiasis 6 x 4 mm) with pyelocalyceal dilation and bilateral ureteral dilation. A simple x-ray of the abdomen showed abdominal distention and dilated bowel with image of radiodense calculus at the level of the bladder (Figure 1). He was subsequently administered antibiotics, anti-fungal and anti-parasite medications, alkalizing agents, diuretics, and treated with peritoneal dialysis with a Tenckhoff catheter.