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End-Stage Renal Disease in Children

The pediatrician should be able to identify chronic renal failure and to determine a specific etiobogic diagnosis for most patients with CRF, based upon age and mode of presentation, examination of the urine, anatomic evaluation of the urinary tract, and, if indicated, relatively simple laboratory tests, such as antinuclear antibody and serum complement. While referral to a pediatric urologist is indicated for diagnosis and management of congenital malformations of the urinary tract, consultation with the pediatric nephrologist is advisable for the child who requires a renal biopsy for definitive diagnosis, as well as to plan future management, including diet, drug therapy, dialysis, and transplantation. The primary care pediatrician should retain responsibility for implementing the medical recommendations of the pediatric urologist or nephrologist and should resume his full role for the child who has undergone successful renal transplantation.