Chronic Renal Failure in Children

Introduction:

Chronic renal failure is a situation of an irreversible reduction in glomerular filtration rate (GFR) with a prevalence at 18 per million and may be congenital or acquired.
KDQI defines chronic kidney disease (CKD) as a kidney damage with GFR of
< 60 ml/m2/ 1.73m² for >= 3 months.
Whatever is the kidney cause, there is
irreversible sclerosis and loss of nephrons which leads to reduction in GFR

Clinical staging

Stage 1

  • kidney damage with normal GFR > 90ml/min

Stage 2

  • mild reduction in GFR 60-69  ml/mm/1.73m

Stage 3

  • mild reduction in GFR 30-59 ml/mm/1.73m²

Stage 4

  • severe reduction in GFR 15-29″ “

Stage 5

  • kidney failure GFR <15ml/mm

Different formulae for GFR but Schwatz is the most commonly used:
Height x k(constant) K is age and sex dependent SCR
The cause is age dependent: <5yrs commonly from anatomic anomalies and for > 5yrs, acquired glomerular disease.
Glomerulonephritis, Urinary Tract Obstruction, REFLUX, Congenital anomalies and urinary tract infection are leading causes.

Clinical features

  • Non-specific: headache, fatigue, lethargy, anorexia, vomiting, growth failure
  • Specific: anaemia, oliguria, anuria, puffiness

Investigation

  • RUSS, renal radionucleid scan, CT scan, MRI, VCUG, urinalysis, spot urine for total protein : cr, 24 HUP-total protein, creatinine clearance, serum complements C3, anti GBM antibodies, HBV, HCV,
    Retroviral screening, serum electrolyte, urea and creatinine, serum Ca, phosphate, uric acid, complete blood count

Treatment

Goal is to delay progression if possible, treat pathologic manifestation, renal transplantation.
Treatment of underlying conditions like UTI, Glomerulonephritides; control of BP with ACE inhibitors which also delay: progression through the reduction of protein excretion; control of lipidemia; avoid nephrotoxins

For Anaemia

  • Avoid blood Transfusion – do not
    initiate transfusion until PCV is <30% and aim to maintain PCV at 30%;
  • Treat iron deficiency either orally or parenterally;
  • Erythropoetin either SC or IV;
  • Electrolyte; diet – protein restriction