Renal complications of diabetes mellitus are not well treated by primary care system even when there is endocrinologist follow up in many developing countries. And that was the time the patients presented with either frank generalized edema or sepsis and renal function tests were requested. In the last year I have seen several patients in whom diagnosis of chronic renal failure secondary to diabetes was made when they were brought to the hospital by severe acidosis and very advanced renal failure. They needed urgent dialysis. This disparity between diabetic management on the one hand and awareness of renal complications on the other is a very frequent finding.
Malaria is still endemic in many African countries.
Renal failure secondary to this preventable infectious disease is still a challenge in the many countries. Increasing number of patients with AIDS and its well known renal complication is another disaster that should be seriously considered. Poor access to dialysis in many countries like India and some of the African ones. Poor quality of surgery for the permanent dialysis vascular access and its complications. Losing renal patients due to frequent vascular failure and repeated surgeries and sepsis is not an infrequent observation in the dialysis patients in the developing world.