Downstate's Pediatric Nephrology Division is among the city's largest

Dr. Noosha Baqi feels at home on the teeming streets of Brooklyn. She has enjoyed that sense of familiarity since her arrival in this country almost fifteen years ago.

"I'm a very urban person," she says. "I grew up in Karachi, in Pakistan. It's quite a big city, so New York has always felt like home to me."

That sense of ease shapes her work at one of the city's largest medical centers for children with kidney disorders. Dr. Baqi is director of the Division of Pediatric Nephrology at Downstate. The division offers help for children who suffer from congenital or disease-related damage to their kidneys.

"I enjoy working with children," she says. "I find it very challenging, and rewarding. Since we're in central Brooklyn, the problems often are related to poverty and lack of facilities."

Located on the fourth floor of Downstate's University Hospital of Brooklyn, the Division of Pediatric Nephrology is the major regional center for cases from Brooklyn, Staten Island, and Queens, as well as from Nassau and Suffolk Counties. In 1994-95, the division logged 2,018 ambulatory visits. This year, 256 new patients visited Dr. Baqi and her associates.

The division's services include inpatient admissions, acute care hemodialysis, the maintenance of chronic hemodialysis, and peritoneal dialysis. Earlier this year, the division began offering peritoneal dialysis on an outpatient basis.

"This was a new approach for us," says Dr. Baqi. "We started training patients and parents in January, and we had patients on machines at home by March."

Outpatient peritoneal dialysis offers minimal interference in family and school routines. "It's the preferred modality for children," says Dr. Baqi. "It frees them from the hospital." The division's nurses and staff train children and parents to use a plug-in machine that they can keep in the child's bedroom. Using the machines, children can be dialyzed while they sleep at night.

The causes for kidney disease in children often differ. "Adults commonly develop kidney disease after years of having diabetes or hypertension," Dr. Baqi explains.

Kidney disease in children usually stems from congenital disorders or specific illnesses. "When there is a congenital problem, such as obstructive disease, it can be treated by surgery," says Dr. Baqi. "One of our great strengths at Downstate is the excellent team of pediatric urologists and anesthesiologists."

Transplant surgeons also work closely with the division, providing vascular access for dialysis and, when available, kidney transplantation, the preferred treatment for renal failure.

Some kidney disorders can be traced to problems like urinary tract infection. Others appear to be genetic. Inner-city problems also have had an impact on childhood kidney disease. "We've been seeing some more HIV-related kidney problems," says Dr. Baqi. "The problem is still new, and we haven't had enough experience with it to draw many conclusions."

The division also offers a Pediatric Renal Fellowship Program. This accredited, three-year program is devoted to the clinical care of a variety of patients--those who are hospitalized, recovering from surgery, or being treated on an outpatient basis. The fellowship, says Dr. Baqi, adds to the quality of care that patients enjoy.

Dr. Baqi earned her medical degree at the Dow Medical College in Karachi, Pakistan. In the United States, she served a pediatric internship and residency at Harlem Hospital. She also was a fellow in pediatric nephrology at the Albert Einstein College of Medicine. The author and co-author of numerous scholarly articles, she collaborates closely with another Downstate pediatric nephrologist, Dr. Anup Singh.

Dr. Baqi is proud of the care that the division provides for an often underserved population. "It's an excellent team," she says. "I feel privileged to be a part of this institution and to be able to provide a vital service to the community."