Chronic Kidney Disease in Children

CKD in children has unique etiologies compared to adults, with the majority of pediatric CKD caused by congenital anomalies of the kidney and urinary tract (CAKUT). Additional etiologies include primary and secondary glomerular disorders and cystic and hereditary kidney diseases. The natural history of CKD in children is characterized by a steady decline in kidney function over time, although children with CAKUT tend to have a slower decline compared to children with glomerular disorders. Interventions to slow progressive kidney disease in children and diminish CVD risk factors include strict control of blood pressure and correction of anemia, dyslipidemia, and calcium-phosphate balance. When children with CKD progress to ESRD, pre-emptive transplantation is the preferred method of RRT, but HD remains the most common initial therapeutic modality. CKD has a multitude of effects on childhood health including CVD, impaired nutrition and growth, anemia, bone disease and neurocognitive deficits. Children with CKD have an increased risk of early mortality.