Chronic kidney disease

This chapter discusses all aspects of chronic kidney disease in childhood.

Renal dysplasia and other manifestations in syndromic diseases

Renal abnormalities can occur alone or as part of a syndrome. Many children with chromosomal defects have renal abnormalities.

Infections and the kidney

Many infections can affect the kidney, either by direct invasion or by immune mechanisms. This chapter describes the commoner infections.

Renal calculi and nephrocalcinosis

Urolithiasis and nephrocalcinosis can be associated with substantial morbidity: stones can lead to obstruction and/or infection, which can lead to loss of kidney function, if not treated promptly. Nephrocalcinosis is often associated with a urinary concentrating defect, predisposing to dehydration. This chapter discusses the underlying causes of renal calculi and nephrocalcinosis, their diagnosis, and the acute and chronic management.

Urinary tract infection

Urinary tract infections are important because they may be caused by a structural renal abnormality, diagnosis of which may prevent further renal damage. The importance of collection of the sample and its analysis is vital to prevent unnecessary invasive investigations.

Drug prescribing

Great care should be exercised when prescribing for children with kidney disease. Many drugs are renally excreted and require dose adjustment in the presence of chronic kidney disease. Children with kidney disease, particularly those who have undergone kidney transplantation, frequently receive a large number of drugs and there is significant potential for drug–drug interaction. Information is available in the British National Formulary for Children and other texts; however, advice from an experienced paediatric nephrologist or specialist renal pharmacist should be sought where there is uncertainty.

Peritoneal dialysis in end-stage kidney disease

This chapter describes the principles of peritoneal dialysis, the insertion of the peritoneal dialysis catheter, prevention and treatment of infection, the peritoneal dialysis prescription, and assessment of the dialysis provision.

Hypertension

In children, hypertension by definition affects <5% of the paediatric population. In contrast to adults, where hypertension is typically idiopathic, a primary cause is often identified, especially in young children. This chapter reviews the definition and diagnosis of hypertension and the work-up to identify a potentially underlying cause. The latter is critical to instigate appropriate treatment.

Systemic disease affecting the kidney

Many systemic diseases affect the kidney. This chapter describes the most common and significant ones.

Congenital abnormalities of the kidneys and urinary tract

Congenital abnormalities of the kidneys and urinary tract (CAKUT) are the commonest cause of renal problems in children, ranging from asymptomatic or incidental findings to a cause of urinary tract infection and obstruction, renal damage, and end-stage kidney disease. The investigation and management of CAKUT depend on the potential for causing renal injury.