Abstract
Chronic kidney disease (CKD) in children varies in severity, ranging from mild reduction in glomerular filtration rate (GFR) without long-term consequences to end-stage renal disease (ESRD), necessitating dialysis or kidney transplantation for continued patient survival. Staging of CKD is primarily based on GFR, while the degree of proteinuria and a number of other factors affect prognosis and may predict individual patient outcome. Linear growth retardation, abnormal neurocognitive development, premature onset of cardiovascular disease, and high prevalence of congenital abnormalities of the kidneys and the urinary tract are among the special challenges associated with CKD in this young population. Significant data have emerged on childhood CKD management, providing evidence guiding physicians caring for these children. Early institution of supportive therapies and drug treatment aimed at reducing CKD progression and extrarenal complications is essential. Affected children should preferably be seen in specialized multidisciplinary clinics where timely input from various pediatric subspecialties and transplant surgeons is readily accessible. Adequate follow-up to monitor disease progression and both compliance and effect of prescribed therapies is needed to reduce CKD associated complications and to optimize renal and patient outcome. When patients progress to ESRD, preemptive renal transplantation is likely the best renal replacement therapy option, avoiding the significant dialysis associated morbidity. Optimal timing of transplant surgery is when the outcome of conservative CKD management is less than what is expected following successful kidney transplantation.
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Abbreviations
- ABPM:
-
Ambulatory blood pressure monitoring
- ACEi:
-
Angiotensin-converting enzyme inhibitor
- ACR:
-
Albumin-to-creatinine ratio
- ALP:
-
Alkaline phosphatase
- APRT:
-
Adenine phosphoribosyltransferase
- ARB:
-
Angiotensin II receptor blocker
- CAKUT:
-
Congenital anomalies of the kidney and urinary tract
- CKD:
-
Chronic kidney disease
- CKD-MBD:
-
Chronic kidney disease-mineral and bone disorder
- CKiD:
-
Chronic Kidney Disease in Children Study
- CO2:
-
Serum bicarbonate
- CRP:
-
C-reactive protein
- eGFR:
-
Estimated glomerular filtration rate
- ERA-EDTA:
-
European Renal Association-European Dialysis and Transplant Association
- ESA:
-
Erythropoiesis-stimulating agents
- ESRD:
-
End-stage renal disease
- FGF-23:
-
Fibroblast growth factor-23
- GFR:
-
Glomerular filtration rate
- GH:
-
Growth hormone
- GN:
-
Glomerulonephritis
- HD:
-
Hemodialysis
- HDL-C:
-
High-density lipoprotein cholesterol
- Hgb:
-
Hemoglobin
- IDDM:
-
Insulin-dependent diabetes mellitus
- IGF-1:
-
Insulin-like growth factor 1
- KDIGO:
-
Kidney Disease: Improving Global Outcomes
- KDOQI:
-
Kidney Disease and Outcome Quality Initiative
- LDL-C:
-
Low-density lipoprotein cholesterol
- LMW:
-
Low molecular weight
- LVH:
-
Left ventricular hypertrophy
- NAPRTCS:
-
North American Pediatric Renal Trials and Collaborative Studies
- PD:
-
Peritoneal dialysis
- pmarp:
-
Per million age-related population
- PTH:
-
Parathyroid hormone
- rhGH:
-
Recombinant human growth hormone
- RRT:
-
Renal replacement therapy
- SCr:
-
Serum creatinine
- SDS:
-
Standard deviation score
- SPS:
-
Sodium polystyrene sulfonate
- TG:
-
Triglycerides
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Edvardsson, V.O. (2018). Causes of Pediatric Kidney Failure, Treatment of Chronic Kidney Disease, and Timing of Transplantation. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07284-5_27
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