Chronic kidney failure in children

Chronic kidney failure in children is a nonspecific syndrome that develops with an irreversible decrease in the homeostatic functions of the kidneys due to their severe progressive disease.

ICD-10 codes

• N18.0. Terminal stage of kidney damage.
• N18.8. Other manifestations of chronic renal failure.
• N18.9. Chronic renal failure, unspecified.

Epidemiology

According to the literature, the incidence of chronic renal failure among children is 3-50 per 1,000,000 children. Annually, 4-6 people from 1 000 000 patients under the age of 15 years need the beginning of renal replacement therapy in connection with chronic kidney failure.

[1], [2], [3], [4], [5], [6], [7],

Risk factors for chronic renal failure in children

The main risk factors for the development of chronic renal failure:

• torpid progressive progression of nephropathy;
• early reduction of renal function;
• renal dysembryogenesis;
• increasing instability of cell membranes;
• drug infusion.

The risk group for the development of chronic renal failure includes patients suffering from:

• tissue renal dysembryogenesis;
• severe uropathies;
• tubulopathy;
• hereditary nephritis;
• sclerosing variants of jade.

Causes of chronic renal failure

How does chronic renal failure develop in children?

It was found that in the majority of patients with GFR of about 25 ml / min and below, terminal chronic renal failure is inevitable, regardless of the nature of the disease. There is an adaptive response of intrarenal hemodynamics to the loss of mass of the active nephrons: a decrease in the resistance in the afferent (more pronounced) and efferent arterioles of functioning nephrons, leading to an increase in the rate of intra-cell plasma flow, i.e., hyperperfusion of the glomeruli and increased hydraulic pressure in their capillaries.

Pathogenesis of chronic renal failure

Symptoms of chronic renal failure in children

In the initial stage of chronic renal failure, patients' complaints and clinical symptoms can to a large extent be related to the underlying disease. Unlike acute renal failure, chronic renal failure develops gradually. The clinical picture is more often formed with GFR less than 25 ml / min. Complications, lesions of other organs and systems in chronic kidney failure in children occur earlier than in adults, and are more pronounced.

Symptoms of chronic kidney failure

Classification of chronic renal failure

There are many different classifications of renal dysfunction, developed by domestic and foreign authors and based on different principles. As the latter are: the value of glomerular filtration, the concentration of serum creatinine, a violation of tubular function and the staging of clinical symptoms. In our country there is no single generally accepted classification of renal dysfunction in children.

Types of chronic renal failure

[8], [9], [10], [11], [12]

Diagnosis of chronic renal failure

Stages of diagnosis of chronic renal failure.

• Anamnesis of the disease: the presence and duration of proteinuria, arterial hypertension, delay in physical development, recurrent infection of the urinary system,
• Family history: indications of polycystosis, Alport syndrome, systemic connective tissue diseases, etc.
• Objective examination: stunted growth, lack of body weight, deformations of the skeleton, signs of anemia and hypogonadism, increased blood pressure, ocular fundus abnormalities, decreased acuity of hearing,

Diagnosis of chronic renal failure

[13], [14], [15], [16], [17], [18],

Treatment of chronic renal failure in children

Before the treatment of a patient with chronic renal insufficiency, it is necessary to determine the disease that led to the development of renal failure, the stage and the main clinical and laboratory symptoms of impaired renal function. An unambiguous interpretation of these important indicators, and hence the use of identical terminological and diagnostic approaches, is considered important for the tactics of conducting.

Patients with chronic renal insufficiency need correction of diet and syndrome treatment.

How is chronic renal failure treated?

Prophylaxis of chronic renal failure in children

Measures to prevent sclerosis of the renal parenchyma and reduce the mass of functioning nephrons, leading to a reduction in the risk of developing chronic renal failure:

• prenatal diagnosis of various malformations of the urinary tract;
• timely surgical correction of obstructive uropathies;
• effective treatment of acquired kidney diseases and evaluation of the factors of progression.

Forecast

Each of the methods of renal replacement therapy is characterized by a certain period of survival, and transplantation is also considered not a final, but only one of the stages of treatment. After loss of the function of the transplant, it is possible to return to peritoneal dialysis or if the peritoneal function is lost - transfer to hemodialysis followed by a second transplantation. The current level of development of renal replacement therapy allows us to predict several decades of active and fulfilling life. Nevertheless, chronic renal failure is considered a progressive disease and mortality among children receiving dialysis is 30-150 times higher than in the general population. At the present stage, life expectancy for a child who began to receive dialysis before the age of 14 is about 20 years (US data). That is why the diagnostic and therapeutic approach to chronic renal failure should be directed to primary prevention, early diagnosis and active treatment at all stages.

[19], [20], [21], [22], [23]