Chronic kidney disease in children

Abstract

Chronic kidney disease (CKD) is a major health problem worldwide. Although relatively uncommon in children, it can be a devastating illness with many long-term consequences. CKD presents unique features in childhood and may be considered, at least in part, as a stand-alone nosologic entity. Moreover, some typical features of paediatric CKD, such as the disease aetiology or cardiovascular complications, will not only influence the child's health, but also have long-term impact on the life of the adult that they will become. In this review we will focus on the unique issues of paediatric CKD, in terms of aetiology, clinical features and treatment. In addition, we will discuss factors related to CKD that start during childhood and require appropriate treatments in order to optimize health outcomes and transition to nephrologist management in adult life.

Keywords: CKD; ESRD; chronic renal failure; chronic renal insufficiency; paediatrics.

Fig. 1.

Estimated prevalence of CKD (top) and ESRD (bottom) in children worldwide. Data are collected by NAPRTCS, the Italian registry, USRDS, ESPN/ERA-EDTA registry, ANZDATA and the Japanese registry [, –16]. Incidence and prevalence are reported as number of patients per million of age-related population (pmarp) per year and number of patients pmarp, respectively. Data from the ESPN/ERA-EDTA registry are reported on the basis of the contribution to the European registry of each single country, as available at www.espn-reg.org/index.jsp. CKD, chronic kidney disease; ESRD, end-stage renal disease.

Fig. 2.

Impact of different causes of CKD in children among age groups. The graph shows the variation of the impact of different diagnostic groups in determining CKD over time, highlighting how glomerular diseases significantly increase in older children, while structural disorders are more common as causes of CKD in infants and younger children. CKD, chronic kidney disease; FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; yrs, years.

Fig. 3.

Clinical complications of CKD: a double perspective. The picture shows the correspondence between clinical features and complications of CKD with onset during childhood (left, top) and the relative consequences in adult life (right, top). On the other hand, clinical and laboratory findings of kidney disease in an adult (right, bottom) may find an explanation in kidney functional and/or structural abnormalities that already existed during infancy and childhood (left, bottom) but that may have been missed or underdiagnosed because of being clinically silent. Therefore, nephrologists, should have a global vision of their patients, regardless of whether the patient with CKD is a child or an adult: the first with a look towards the future, the other to the past. To underline this aspect, each box on the left side of the picture corresponds to one on the right side, as highlighted by the colour code. CKD, chronic kidney disease; GH-IGF-I, growth hormone and insulin-like growth factor I; LVH, left ventricular hypertension; CKD-MBD, chronic kidney disease–mineral and bone disorder; CV, cardiovascular; FSGS, focal segmental glomerulosclerosis.