Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Most commonly results from developmental abnormalities of the kidneys or urinary tract. Obstructive uropathy or severe vesicoureteral reflux (VUR) without (or despite) surgical intervention is often associated with progressive kidney disease in children In older children, the chronic glomerulonephritides, irreversible nephrotoxic injury, or hemolytic-uremic syndrome may also cause chronic kidney disease (CKD) +++ Complications ++ Polyuria and dehydration are more likely than fluid overload in children who have structural kidney lesions associated with impaired urinary concentration Salt-wasting state can occur However, sodium and water retention with associated hypertension and eventual loss of urinary output is characteristic in children with CKD due to glomerular disease or acute kidney injury Metabolic acidosis and growth retardation occur early in CKD Disturbances in calcium, phosphorus, and vitamin D metabolism leading to renal osteodystrophy and rickets require prompt attention Anemia due to decreased erythropoietin production can occur relatively early Anorexia, nausea, and malaise occur late in CKD (generally < 30% renal function) CNS abnormalities such as confusion and lethargy are very late symptoms, followed even later by stupor and coma Unusual in children because medical attention is sought before deteriorating to this point Rise in blood urea nitrogen (BUN) is typically gradual Other late complications of untreated CKD are platelet dysfunction and bleeding tendencies, pericarditis, and chronic fluid overload leading to heart failure, pulmonary edema, and worsening hypertension +++ Treatment of Complications ++ Acidosis may be treated with sodium citrate or bicarbonate solutions, as long as the added sodium does not aggravate hypertension Sodium restriction is advisable when hypertension is present Hyperphosphatemia is controlled by dietary restriction and dietary phosphate binders (eg, calcium carbonate, sevelamer) Supplementation with vitamin D (cholecalciferol or ergocalciferol) and calcitriol Typically required Target the prevention of renal osteodystrophy or rickets Dietary potassium restriction will be necessary as the glomerular filtration rate falls Renal function must be monitored regularly (creatinine and BUN) Serum electrolytes, calcium, phosphorus, intact parathyroid hormone, iron and ferritin, and hemoglobin and hematocrit levels must be monitored to guide changes in Fluid and dietary management Dosages of phosphate binder, citrate buffer, vitamin D supplements, blood pressure medications, iron supplements, and epoetin alfa Linear growth failure may be treated with daily subcutaneous human recombinant growth hormone Avoid medications that Aggravate hypertension Increase the body burden of sodium, potassium, or phosphate Increase production of BUN +++ Treatment: Dialysis ++ Chronic peritoneal dialysis (home-based) and hemodialysis provide lifesaving treatment for children prior to kidney transplantation +++ Outcome +++ Prognosis ++ Graft survival rate for living-related kidney transplants 90% at 1 year 85% at 2 years 75% at 5 years Graft survival rates for cadaveric transplantation 76% at 1 year 71% at 2 years 62% at 5 years Overall, the mortality rate is 4% for recipients of living-related donors and 6.8% for recipients of cadaver ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.