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Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function present for ≥ 3 months. The chief markers of kidney damage include either decreased glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 or albuminuria. Additional markers are the presence of urine sediment abnormalities, electrolyte disturbances due to tubular disorder, abnormalities detected either by imaging or kidney biopsy, or a history of kidney transplantation. In addition, a defined staging system has evolved to classify the severity of CKD and guide clinical management, as certain manifestations and complications of CKD arise at specific GFR levels irrespective of the etiology of CKD. In 2012, Kidney Disease Improving Global Outcome (KDIGO) guidelines modified this staging system to include albuminuria, as the relative risk of mortality, cardiovascular complications, and disease progression is influenced independently by both GFR and albuminuria (Table 473-1). There are a number of caveats with respect to applying this classification system to pediatrics. First, the staging of CKD excludes patients younger than 2 years whose renal function improves markedly in the first 2 years of life; therefore, a GFR < 90 mL/min/1.73 m2 in a 6-month-old child may not represent any abnormality of renal function. Second, the duration of ≥ 3 months to define CKD cannot be applied to newborns and infants younger than 3 months of age. Finally, in children, urinary protein excretion can be used instead of albumin excretion.



The causes of CKD in children are very different from those in adults. In younger children, the ...

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