Chronic kidney disease in children: An indian perspective

Abstract

Chronic renal failure (CRF) is an insidious and irreversible condition that eventually progresses to end stage renal failure. It is an important cause of morbidity and mortality in children worldwide. The disease process is better termed as chronic kidney disease (CKD), in order to encompass the entire spectrum and severity of renal disease. In the past various terminologies have been used to describe its severity from chronic renal insufficiency to end stage renal disease (ESRD). This classification did not include the ‘at risk’ population where intervention could modify the outcome. In order to reduce ambiguity and use more objective terms of reference the new name of CKD was introduced. Chronic kidney disease is defined primarily as an abnormality of kidney function or structure as determined by laboratory tests, urinalysis or imaging tests, which have been present for three or more months. Importantly, the classification system describes the stages according to level of estimated glomerular filtration rate (GFR), not serum creatinine levels. This staging uses various clinical, laboratory and imaging parameters [1] and is depicted in Table 1. These stages correspond to the severity of kidney function loss and the prevalence of co-morbidities associated with kidney disease. The identification of low GFR states may allow the implementation of simple measures to prevent worsening. For these reasons, it may be prudent to adopt the system of defining kidney disease according to kidney function, not serum creatinine values. However certain grey areas exist with this classification. The staging takes into consideration normal GFR for a western population. It has been noted that healthy Indians especially on a vegetarian diet have a lower GFR [2]. Secondly, correct interpretation of GFR values in children and adolescents, requires a clear understanding that it varies according to age, gender, and body size. The normal GFR in young adults is 120 to 130 mL/min/1.73 m2, whereas in infancy it is much lower. Even when corrected for body surface area it increases in relationship to body size up to two years. Kidney disease is characteristically asymptomatic and is often not diagnosed until it is relatively advanced. Table 1 Stages of chronic kidney disease