Chronic Kidney Disease in Children

Objectives

After completing this article, readers should be able to:

1. Define chronic kidney disease (CKD).

2. Immunize a patient scheduled for renal transplantation.

3. Assess and manage growth and development in a patient who has CKD.

4. Discuss the risks and benefits of renal transplantation, including the advantages and disadvantages of living donor versus deceased donor transplantation.

Introduction

Prior to 2002, the term chronic renal insufficiency was used to characterize patients who had progressive decline in renal function, defined as a glomerular filtration rate (GFR) of less than 75 mL/min per 1.73 m² body surface area. Chronic kidney disease (CKD) is the new term defined by the National Kidney Foundation Kidney Disease and Outcome Quality Initiative (KDOQI) Group to classify any patient who has kidney damage lasting for at least 3 months with or without a decreased GFR or any patient who has a GFR of less than 60 mL/min per 1.73 m² lasting for 3 months with or without kidney damage. The KDOQI Group also classified CKD into five stages:

• Stage 1: Kidney damage with a normal or increased GFR (>90 mL/min per 1.73 m²)

• Stage 2: Mild reduction in the GFR (60 to 89 mL/min per 1.73 m²)

• Stage 3: Moderate reduction in the GFR (30 to 59 mL/min per 1.73 m²)

• Stage 4: Severe reduction in the GFR (15 to 29 mL/min per 1.73 m²)

• Stage 5: Kidney failure (GFR <15 mL/min per 1.73 m² or dialysis)

GFR values for CKD staging are for children older than 2 years of age because the GFR values for younger children are low due to ongoing renal maturation. Children who have CKD may present to clinicians with a combination of problems involving growth, nutrition, electrolyte disturbances, renal osteodystrophy, anemia, immunizations, hypertension, and renal transplantation. …