7,039 11,415 East Asia and the Pacific 1,850,775 233 5,400 1,858 3,530 Europe and Central Asia 447,180 53 1,417 623 793 Latin America and the Caribbean 526,138 70 1,667 779 888 Middle East and North Africa 309,762 57 1,283 460 823 South Asia 1,387,873 156 3,991 1,373 2,619 Sub-Saharan Africa 667,663 107 2,623 1,046 1,576 Source: Mathers and others 2006. Table 36.2 Global Deaths Caused by Diseases of the Genitourinary System by Gender and Age Age (years) Gender Birth–4 5–14 15–29 30–44 45–59 60–69 70–79 80+ Male deaths Number (thousands) 11 7 24 43 80 86 110 88 Percent 3 2 5 10 18 19 24 20 Female deaths Number (thousands) 10 6 21 29 61 66 85 98 Percent 3 2 5 8 16 18 23 24 Source: WHO 2002. glomerulosclerosis have different causes, both can lead to ESRD. Glomerulonephritis ranks second after diabetes as the foremost cause of ESRD in Europe. (Stengel and others 2003) and is the second leading cause of ESRD in the United States, according to the United States Renal Data System (http://www. ifrr.net/). Approximately 20 to 35 percent of patients requiring RRT have a glomerular disease. Glomerular diseases are more prevalent and severe in tropical regions and low-income countries (Seedat 2003).A common mode of presentation is the nephrotic syndrome, with the age of onset at five to eight years. Estimates indicate that 2 to 3 percent of medical admissions in tropical countries are caused by renalrelated complaints, most resulting from glomerulonephritis. A number of kidney diseases that result from infectious diseases, such as malaria, schistosomiasis, leprosy, filariasis, and hepatitis B virus, are exclusive to the tropics. HIV/AIDS can be complicated by several forms of kidney disease; however, patient data are sparse (Seedat 2003). Acute poststreptococcal nephritis following a throat or skin infection caused by Group A streptococcus has almost disappeared in high-income countries because of improved hygiene and treatment but remains an important glomerular disease in India and Africa, where epidemics have been reported (Seedat 2003). The eradication of endemic infections, along with improvements in socioeconomic status, education, sanitation, and access to treatment, is a crucial step toward decreasing the incidence of glomerular diseases in developing countries. Infections, Stones, and Obstructive Uropathy Infections of the urinary tract are a common health problem worldwide and can be categorized as either uncomplicated or complicated. Uncomplicated infections include bladder infections such as cystitis, seen almost exclusively in young women (Hooton 2000). Among sexually active women, the incidence of cystitis is 0.5 episodes per person annually, and recurrence develops in 27 to 44 percent of cases. Acute, uncomplicated pyelonephritis, involving the kidney, is less frequent in women than is cystitis. Males are less susceptible to acute, uncomplicated infections of the bladder or the kidney, with an incidence of five to eight episodes per 10,000 men annually. Even though uncomplicated urinary tract infections are considered benign, they have significant medical and financial implications estimated at approximately US$1.6 billion per year (Foxman 2003). As for complicated urinary tract infections, hospitalization results in almost 1 million such infections per year in the United States. Bladder catheterization is the most important cause. Developing countries exhibit a different pattern of urinary tract infection. Obstructive or reflux nephropathy is often attributed to urinary schistosomiasis (Barsoum 2003). Worldwide, 200 million people are affected and an estimated 300 million are at risk. The disease causes lesions in the bladder and predisposes those with the condition to secondary infections, bladder cancers, and chronic pyelonephritis. Some 15 to 20 million people have tuberculosis (TB) worldwide, of whom 8 million to 10 million are infectious. Genitourinary TB is a common form of extrapulmonary TB and is always secondary to the primary lesion, which usually occurs in the lung (Pasternak and Rubin 1997). Lesions referred to as ulcero-cavernous or miliary affect the kidneys. If left untreated, such lesions may progress to kidney destruction. Early recognition of and effective therapy for TB substantially decrease the consequences in relation to kidney function. In the industrial countries, kidney stones are a common problem (Morton, Iliescu, and Wilson 2002), affecting 1 person in 1,000 annually, and the incidence is increasing in tropical developing countries (Robertson 2003). Factors such as age, sex, and ethnic and geographic distribution determine prevalence. The peak age of onset is in the third decade, and prevalence increases with age until 70. Although largely idiopathic, the following risk factors are associated with stone disease: low urine volume, hyperuricosuria, hyperoxaluria, hypomagnesuria, and hypocitraturia. Diarrhea, malabsorption, low protein, low calcium, increased consumption of oxalate-rich foods, and low fluid intake may play a role in the genesis of stone disease. In developing countries, 30 percent of all pediatric urolithiasis cases occur as bladder stones in children. The formation of bladder stones in children is caused by a poor diet high in cereal content and low in animal protein, calcium, and phosphates. Kidney stones can