Chronic kidney disease
Most children with CKD are asymptomatic until approaching chronic renal disease stage 4.
Chronic kidney disease (CKD)
Most children with CKD are asymptomatic until approaching chronic renal disease stage 4 (see Table 11.7). CKD should be suspected if:
- failure to thrive;
- polyuria and polydipsia;
- lethargy, lack of energy, poor school concentration;
- other abnormalities such as rickets.
CKD: Correcting common misconceptions
- Plasma creatinine can remain normal until GFR is reduced to <50%.
- The urine flow rate may not mean a good GFR as many children with renal dysplasia have polyuria and nocturia.
- Other urinary abnormalities such as proteinuria, glycosuria can be an indicator of tubular dysfunction.
The focus is on GFR and not plasma creatinine
- GFR can be formally measured by the Iohexol method or alternatively by 51Cr EDTA or inulin methods clearance,
- In ordinary clinical practice GFR (mL/min/1.73m2) may be estimated (note: less accurate in children <2yrs or >14yrs):
GFR (estimated) = 40 × height (cm)/creatinine (µmol/L).
FBC + iron studies if anaemic;
parathyroid hormone (PTH).
- Renal tract US.
- Left hand and wrist X-ray for bone age and renal osteodystrophy score.
- ECG/echocardiography for signs of left ventricular hypertrophy if hypertensive.