Chronic renal failure (CRF) is an irreversible reduction in renal function, or glomerular filtration rate (GFR), with accompanying derangements in biochemical homeostasis. The term chronic kidney disease (CKD) incorporates CRF and chronic renal insufficiency, which are considered part of the spectrum of CKD. End-stage renal disease (ESRD) is defined as CRF so severe that a form of renal replacement therapy (such as peritoneal dialysis) is required. The Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation established standards for the definition and classification of CKD to promote early diagnosis (Table 111-1)1. These standards define CKD as being present in any patient who meets one of two criteria: (1) there is evidence of kidney damage for 3 months or more, as defined by structural abnormalities of the kidney with or without decreased GFR, as evidenced by abnormalities in the composition of blood or urine, abnormalities in imaging tests, or abnormalities on kidney biopsy; (2) the GFR is less than 60 mL/minute per 1.73 m2 for 3 months or more, with or without any structural changes. GFR is not adequately determined using serum creatinine alone; it should be estimated using a prediction equation such as the Schwartz equation (Table 111-3)2.
TABLE 111-1Stages of Chronic Kidney Disease |Favorite Table|Download (.pdf) TABLE 111-1 Stages of Chronic Kidney Disease
|Stage ||GFR (mL/min/1.73 m2) ||Description |
|1 ||≥90 ||Kidney damage with normal or increased GFR |
|2 ||60-89 ||Kidney damage with mild decrease in GFR |
|3 ||30-59 ||Moderate reduction of GFR |
|4 ||15-29 ||Severe reduction of GFR |
|5 ||<15 ||Need for renal replacement therapy |
The incidence of CRF in children is low, and the incidence of ESRD is 9 children per 1 million of the age-related population.1 Unlike adults with CRF, in whom the primary causes are diabetes and hypertension, the overwhelming majority of children with CRF have primary renal disease, usually of a congenital origin.3,4 This means that the care of children with CRF can deviate dramatically from that of adults.
There have been remarkable improvements in the treatment of children with CRF and ESRD, with a subsequent increase in the prevalence of CRF in the pediatric population. Children with CRF are more likely to have polyuria and salt wasting, complicating their care as compared to adults with CRF. Additionally, they have the requirement for growth and development. Normalization of these parameters is the key to successful treatment. These factors, along with the psychosocial issues specific to childhood, make the treatment of children with CRF challenging, but with meticulous care and attention to detail, these children ...