Causes of Pediatric Kidney Failure, Treatment of Chronic Kidney Disease, and Timing of Transplantation

Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)

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.

Keywords

Glomerular filtration rate Glomerular filtration rate decline Epidemiology Chronic kidney disease Chronic renal insufficiency Chronic kidney disease progression Proteinuria Albuminuria Nutrition Growth Metabolic acidosis Mineral and bone disorder Hyperparathyroidism Vitamin D metabolism Anemia Hypertension Dyslipidemia Electrolyte disorders Kidney failure End-stage renal disease Renal replacement therapy Dialysis Transplantation 

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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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of IcelandReykjavikIceland
  2. 2.Children’s Medical CenterLandspitali – The National University Hospital of IcelandReykjavikIceland

Section editors and affiliations

  • Bruce Kaiser
    • 1
  1. 1.Division of Solid Organ Transplantation, EmeritusAlfred I. duPont Hospital for ChildrenWilmingtonUSA

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