Chronic Kidney Disease in Children and Adolescents

Abstract

1. Susan F. Massengill, MD* 2. Maria Ferris, MD, MPH, PhD† 1. *Director, Pediatric Nephrology, Levine Children’s Hospital, Adjunct Associate Professor of Pediatrics, University of North Carolina School of Medicine, Charlotte, NC. 2. †Director, Pediatric Dialysis and Transplant Programs, UNC Kidney Center, Founder and Director, The UNC Children’s Hospital TRxANSITION Program, University of North Carolina at Chapel Hill, Chapel Hill, NC. * Abbreviations: 1,25(OH)2 D: : 1,25-dihydroxyvitamin D ACE: : angiotensin-converting enzyme CKD: : chronic kidney disease CKiD: : Chronic Kidney Disease in Children CVD: : cardiovascular disease eGFR: : estimated glomerular filtration rate ESKD: : end-stage kidney disease GFR: : glomerular filtration rate HCT: : health care transition MBD: : metabolic bone disease Chronic kidney disease (CKD) is a devastating diagnosis with many co-morbidities, increasing the risk of mortality 30 to 150 times that of the general pediatric population. Recognition of at-risk children can lead to earlier screening and risk reduction. Primary care clinicians are often unaware of the comorbid conditions and long-term consequences of CKD, particularly with respect to cardiovascular disease, nutrition and growth, neurocognitive development, and burden of disease. After completing this article, readers should be able to: 1. Be aware of the life course of CKD and its co-morbidities. 2. Recall the risk factors and complications of pediatric CKD. 3. Discuss measures to prevent or delay the progression of pediatric CKD. 4. Optimize the communication between the primary care clinician and nephrologist in treating children, adolescents, and young adults with CKD. A 13-month-old toddler new to your practice presents for his 1-year health maintenance visit with poor growth and developmental delay. He is just now sitting without support and appears to have occasional leg pain. He is pale, weighs 7.9 kg, and has a normal blood pressure. The results of laboratory studies are remarkable for anemia (hemoglobin, 9 g/dL [90 g/L]), profound acidosis (carbon dioxide, 12 mEq/L [12 mmol/L]), azotemia (urea nitrogen, 117 mg/dL [41.8 mmol/L]; creatinine, 2.44 mg/dL [216 μmol/L]), and profound hypocalcemia (calcium, 5.6 mg/dL [1.40 mmol/L]), prompting further evaluation where hypocalcemia was confirmed. Urinalysis revealed a specific gravity of 1.005 and proteinuria (1+). Renal ultrasonography revealed bilateral renal hypoplasia. Renal replacement therapy was initiated with peritoneal dialysis, and the patient is on the renal transplantation waiting list. A previously healthy, 14-year-old, African American girl presents with a 3-month history of facial …