Introduction: Pediatric End-Stage Renal Disease

Abstract

The field of pediatric nephrology requires an understanding of fetal physiology, developmental biology of the kidney, pharmacotherapeutics tailored to an altered metabolism, and the biophysical and psychological effects of normal growth and developmental processes that occur through young adulthood and are often superimposed on the course of chronic kidney disease. In addition, practitioners in this field must be acutely aware of how chronic kidney disease alters the normal course of sexual differentiation during adolescence. We believe that this issue of Advances in Renal Replacement Therapy, which is dedicated to the pediatric patient on maintenance dialysis, represents a state-of-the-art approach as it pertains to several of these important issues for children with kidney failure. Fully one third of children developing kidney failure have an anatomic lesion of the urinary tract, often developmentally acquired. Professor Adrian W 001£ and Nikesh Thiruchelvam present a coherent story of the regulation of kidney development, as but part of an emerging area of translational science about obstructive uropathy. Their review clearly shows how, in the future, both better diagnostic criteria for such lesions and perhaps even genetic modulation of developmental anomalies may be a component of the therapeutic armamentarium of the pediatric nephrologist and urologist. The extrarenal morbidity associated with end-stage renal disease (ESRD) in pediatrics is a topic that demands the utmost attention because of the impact it has on the long-term outcome of this young population. Drs Blanche Chavers and H.William Schnaper collaborate to discuss the recent clinical evidence of and scientific basis for the dramatic alterations of the cardiovascular system that can characterize the child with kidney failure. Dr Uri Alon follows with a comprehensive analysis of the profound effects that chronic kidney disease produces on the growing skeleton. He provides a theoretical and practical framework on which he proposes relevant clinical questions that can be answered only in the setting of multicenter studies. Both discussions are intended to stimulate innovative strategies to