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American Academy of Pediatrics
Article

Chronic Kidney Disease in Children and Adolescents

Susan F. Massengill and Maria Ferris
Pediatrics in Review January 2014, 35 (1) 16-29; DOI: https://doi.org/10.1542/pir.35-1-16
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Susan F. Massengill
*Director, Pediatric Nephrology, Levine Children’s Hospital, Adjunct Associate Professor of Pediatrics, University of North Carolina School of Medicine, Charlotte, NC.
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Maria Ferris
†Director, Pediatric Dialysis and Transplant Programs, UNC Kidney Center, Founder and Director, The UNC Children’s Hospital TRANSITION Program, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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  1. Susan F. Massengill, MD*
  2. Maria Ferris, MD, MPH, PhD†
  1. *Director, Pediatric Nephrology, Levine Children’s Hospital, Adjunct Associate Professor of Pediatrics, University of North Carolina School of Medicine, Charlotte, NC.
  2. †Director, Pediatric Dialysis and Transplant Programs, UNC Kidney Center, Founder and Director, The UNC Children’s Hospital TRxANSITION Program, University of North Carolina at Chapel Hill, Chapel Hill, NC.
  • Author Disclosure

    Drs Massengill and Ferris have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

  • Abbreviations:
    1,25(OH)2 D:
    1,25-dihydroxyvitamin D
    ACE:
    angiotensin-converting enzyme
    CKD:
    chronic kidney disease
    CKiD:
    Chronic Kidney Disease in Children
    CVD:
    cardiovascular disease
    eGFR:
    estimated glomerular filtration rate
    ESKD:
    end-stage kidney disease
    GFR:
    glomerular filtration rate
    HCT:
    health care transition
    MBD:
    metabolic bone disease
  • Educational Gap

    Chronic kidney disease (CKD) is a devastating diagnosis with many co-morbidities, increasing the risk of mortality 30 to 150 times that of the general pediatric population. Recognition of at-risk children can lead to earlier screening and risk reduction. Primary care clinicians are often unaware of the comorbid conditions and long-term consequences of CKD, particularly with respect to cardiovascular disease, nutrition and growth, neurocognitive development, and burden of disease.

    Objectives

    After completing this article, readers should be able to:

    1. Be aware of the life course of CKD and its co-morbidities.

    2. Recall the risk factors and complications of pediatric CKD.

    3. Discuss measures to prevent or delay the progression of pediatric CKD.

    4. Optimize the communication between the primary care clinician and nephrologist in treating children, adolescents, and young adults with CKD.

    Case 1

    A 13-month-old toddler new to your practice presents for his 1-year health maintenance visit with poor growth and developmental delay. He is just now sitting without support and appears to have occasional leg pain. He is pale, weighs 7.9 kg, and has a normal blood pressure. The results of laboratory studies are remarkable for anemia (hemoglobin, 9 g/dL [90 g/L]), profound acidosis (carbon dioxide, 12 mEq/L [12 mmol/L]), azotemia (urea nitrogen, 117 mg/dL [41.8 mmol/L]; creatinine, 2.44 mg/dL [216 μmol/L]), and profound hypocalcemia (calcium, 5.6 mg/dL [1.40 mmol/L]), prompting further evaluation where hypocalcemia was confirmed. Urinalysis revealed a specific gravity of 1.005 and proteinuria (1+). Renal ultrasonography revealed bilateral renal hypoplasia. Renal replacement therapy was initiated with peritoneal dialysis, and the patient is on the renal transplantation waiting list.

    Case 2

    A previously healthy, 14-year-old, African American girl presents with a 3-month history of facial …

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    In this issue

    Pediatrics in Review: 35 (1)
    Pediatrics in Review
    Vol. 35, Issue 1
    1 Jan 2014
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    Chronic Kidney Disease in Children and Adolescents
    Susan F. Massengill, Maria Ferris
    Pediatrics in Review Jan 2014, 35 (1) 16-29; DOI: 10.1542/pir.35-1-16

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    Chronic Kidney Disease in Children and Adolescents
    Susan F. Massengill, Maria Ferris
    Pediatrics in Review Jan 2014, 35 (1) 16-29; DOI: 10.1542/pir.35-1-16
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    • Table of Contents

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    • Article
      • Educational Gap
      • Objectives
      • Case 1
      • Case 2
      • Introduction
      • Epidemiology and Etiology of Pediatric CKD
      • Pathogenesis of CKD
      • Immunizations and CKD
      • Cardiovascular Disease in CKD
      • Metabolic Derangements
      • Hematologic Complications
      • Nutrition and Growth
      • Neurologic and Neurocognitive Effects of CKD
      • Burden of Care, Quality of Life Issues, and Psychosocial Issues in CKD
      • Discussion of Cases
      • Primary Care Clinician Activities to Overcome the Challenges in the Diagnosis and Management of Pediatric-Onset CKD
      • Acknowledgments
      • References
    • Figures & Data
    • Info & Metrics
    • Comments
    • Quiz

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