Causes of chronic renal failure

The development of chronic renal failure is possible already in the neonatal period. In this case, the clearance of creatinine in newborns with chronic renal failure is less than 30 ml / min, and at the age of 6 months they already need dialysis. In the literature, a case of developing a renal insufficiency in a new-born terminal stage ( end stage ) is described on the background of the mother's taking of nimesulide as a tocolytic (to reduce the tone of the uterus). From the second day of life, the child was on dialysis.

The reasons for the development of chronic renal failure in young children are hereditary and congenital nephropathies:

• agenesis or kidney hypoplasia;
• polycystic kidney disease;
• cystic dysplasia;
• developmental defects in the collecting system and kidney structure;
• bilateral hydronephrosis;
• megourater;
• intra- and infra-tubular obstruction.

The causes of chronic renal failure in pre-preschool children:

• hereditary and congenital nephropathies, microcystosis of the kidneys (congenital nephrotic syndrome);
• consequences of the transferred diseases:
  • hemolytic-uremic syndrome (hemolytic anemia, thrombocytopenia, uremia);
  • tubular necrosis;
  • thrombosis of the renal veins, etc.

The causes of chronic renal failure in preschool and school age children:

• acquired kidney disease:
  • chronic and subacute glomerulonephritis;
  • capillarotoxic and lupus nephritis;
  • tubulo-interstitial diseases of the kidneys, etc .;
  • to a lesser extent - hereditary and congenital nephropathies and consequences of the transferred diseases;
  • diabetes mellitus and hypertension (become the leading factors in the development of renal failure in adults only).

The etiology of chronic renal failure in children varies from country to country. Thus, in Finland, congenital nephrotic syndrome is considered as one of the main causes of chronic renal failure. In Argentina, the leading cause of chronic kidney failure in children (in 35% of cases) is hemolytic-uremic syndrome.

The reasons for the development of the terminal stage of chronic renal failure vary considerably between adults and children. If the latter is dominated by congenital diseases and glomerulonephritis, then adults have diabetes mellitus and hypertension.

Knowledge of the causes leading to the development of chronic renal failure, and the peculiarities of its clinical picture in various diseases, allows the development of measures that prevent its progression, and different approaches to conservative treatment.

Factors contributing to the progression of chronic renal failure:

• arterial hypertension;
• proteinuria;
• hyperlipidemia;
• urinary tract infection (to a lesser extent).

The prevalence of diseases that caused the development of the terminal stage of chronic renal failure

Diseases	Children,%	Adults,%
Congenital pathology	39	1
Glomerulonephritis	24	15
Cystic kidney lesions	5	3
Metabolic diseases	3	1
HUS / TTGG	3	1
Diabetes	1	39
Arterial hypertension	0	33
Other	26th	10

* HUS - hemolytic-uremic syndrome; TTL - thrombotic thrombocytopenic purpura.

[1], [2], [3]