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

  • Vidar Orn Edvardsson
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


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.


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 



Ambulatory blood pressure monitoring


Angiotensin-converting enzyme inhibitor


Albumin-to-creatinine ratio


Alkaline phosphatase


Adenine phosphoribosyltransferase


Angiotensin II receptor blocker


Congenital anomalies of the kidney and urinary tract


Chronic kidney disease


Chronic kidney disease-mineral and bone disorder


Chronic Kidney Disease in Children Study


Serum bicarbonate


C-reactive protein


Estimated glomerular filtration rate


European Renal Association-European Dialysis and Transplant Association


Erythropoiesis-stimulating agents


End-stage renal disease


Fibroblast growth factor-23


Glomerular filtration rate


Growth hormone






High-density lipoprotein cholesterol




Insulin-dependent diabetes mellitus


Insulin-like growth factor 1


Kidney Disease: Improving Global Outcomes


Kidney Disease and Outcome Quality Initiative


Low-density lipoprotein cholesterol


Low molecular weight


Left ventricular hypertrophy


North American Pediatric Renal Trials and Collaborative Studies


Peritoneal dialysis


Per million age-related population


Parathyroid hormone


Recombinant human growth hormone


Renal replacement therapy


Serum creatinine


Standard deviation score


Sodium polystyrene sulfonate




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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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