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The definition of chronic kidney disease (CKD) and its different stages are outlined in Table 477-1. The term chronic kidney disease has been introduced to ensure consistency of terminology in relation to patients with sustained renal disorders, and to replace the terms chronic renal insufficiency and chronic renal failure.1 The definition of CKD excludes patients younger than 2 years whose renal function improves markedly in the first 2 years of life; therefore, a glomerular filtration rate (GFR) < 90 mL/min/1.73 m2 in a 6-month-old child may not represent any abnormality of renal function.

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Table 477-1. Stages of Chronic Kidney Disease

Causes of Chronic Kidney Disease in Children


Causes of chronic kidney disease (CKD) in children do not vary substantially between disease registries from a variety of countries.2,3 In younger children, the most common causes are congenital abnormalities of the genitourinary system that are accompanied by vesicoureteric reflux or obstruction to urinary outflow leading to renal hypoplasia or dysplasia. The most common obstructive lesions are posterior urethral valves and prune belly syndrome, both of which only occur in boys (see Chapter 476). Renal cystic diseases, including multicystic kidneys, cystic renal dysplasia, juvenile nephronophthisis, and autosomal-recessive polycystic kidney disease, may cause significant loss of renal function during childhood (see Chapter 470). Glomerular diseases causing significant renal disease in early childhood rarely include congenital nephrotic syndrome, or more commonly, focal segmental glomerulosclerosis or hemolytic uremic syndrome (see Chapter 472). In teenage years, membranous nephropathy and membranoproliferative glomerulonephritis may be seen, and CKD may be seen in association with systemic lupus erythematosus.


Incidence and Prevalence


According to the US Renal Data Systems report, there were 1325 incident patients ages 0 to 19 years with end-stage renal disease or renal transplants treated in 2005, with a prevalent population, including renal transplant patients, of 7362.4 The prevalence is too low to provide accurate estimates of prevalence of each chronic kidney disease (CKD) stage. However, more detailed information is available in the Italian registry from 1990 to 2000, including 1197 children with a creatinine clearance < 75 mL/min/1.73 m2 body surface area (BSA) (predialysis) and age younger than 20 years at the time of registration. This registry reported a mean incidence of 12.1 cases per million (range 8.8–13.9), and the prevalence was 74.7 per million of the ...

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