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Chronic kidney disease
2021-03-03 12:00 AM
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).
Investigations
- Urinalysis.
- Blood:
FBC + iron studies if anaemic;
electrolytes/Ca/PO4/ALP/albumin;
pH/bicarbonate;
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.
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