Causes of chronic renal failure

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

The causes of chronic renal failure in young children are considered to be hereditary and congenital nephropathy:

• renal agenesis or hypoplasia;
• polycystic kidney disease;
• cystic dysplasia;
• malformations of the collecting system and structure of the kidneys;
• bilateral hydronephrosis;
• megaureter;
• intra- and infravesical obstruction.

Causes of development of chronic renal failure in preschool children:

• hereditary and congenital nephropathy, microcystic kidney disease (congenital nephrotic syndrome);
• consequences of past illnesses:
  • hemolytic uremic syndrome (hemolytic anemia, thrombocytopenia, uremia);
  • tubular necrosis;
  • renal vein thrombosis, etc.

Causes of chronic renal failure in preschool and school-age children:

• acquired kidney diseases:
  • chronic and subacute glomerulonephritis;
  • capillary toxic and lupus nephritis;
  • tubulointerstitial kidney diseases, etc.;
  • to a lesser extent - hereditary and congenital nephropathy and the consequences of past diseases;
  • diabetes mellitus and arterial hypertension (become leading factors in the development of renal failure only in adults).

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

The causes of the development of the terminal stage of chronic renal failure differ significantly in adults and children. If the latter are dominated by congenital diseases and glomerulonephritis, then in adults - diabetes mellitus and arterial hypertension.

Knowledge of the causes leading to the development of chronic renal failure and the characteristics of its clinical picture in various diseases allows us to develop measures to 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).

Prevalence of diseases that cause the development of terminal stage 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 mellitus	1	39
Arterial hypertension	0	33
Other	26	10

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

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