Early recognition of paediatric kidney disease in low- and middle-income countries: Clinical red flags and referral strategies for primary care

Chronic kidney disease (CKD) in children is an important but often under-recognized cause of long-term morbidity, particularly in low- and middle-income countries (LMICs) where delayed diagnosis is common. Early manifestations are frequently subtle and include oedema, haematuria, proteinuria, recurrent urinary tract infections, growth failure, hypertension, and unexplained anaemia. This review highlights practical clinical red flags that should prompt evaluation for kidney disease, outlines low-cost investigations feasible in primary care, and summarizes indications for timely nephrology referral. Emphasis is placed on careful history-taking, targeted physical examination, blood pressure measurement, urinalysis, serum creatinine estimation, and renal ultrasonography where indicated. Strengthening awareness among frontline healthcare providers and caregivers, together with structured referral pathways, may facilitate earlier diagnosis, preserve kidney function, reduce preventable complications, and improve long-term outcomes for children with kidney disease in resource-limited settings.