End Stage Renal Disease End Stage Renal Disease in Childrenin Children

End Stage Renal Disease End Stage Renal Disease in Childrenin Children

End stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life it usually occurs as chronic renal failure worsens to the point where kidney function

is less than 10% of normal

At this point the kidney function is so low that without dialysis or kidney transplantation, complication are multiple and severe, and death will occur from accumulation and waste products in the body

IncidenceIncidenceIncidenceIncidence

Incidence rates for children (0 to 19 years old),

adjusted for age, race, and sex, average 10 to

12 per million adjusted population, a rate that

has not changed substantially in more than a

decade.

Incidence rates for children (0 to 19 years old),

adjusted for age, race, and sex, average 10 to

12 per million adjusted population, a rate that

has not changed substantially in more than a

decade.

Primary Disease Leading To CRFPrimary Disease Leading To CRFPrimary Disease Leading To CRFPrimary Disease Leading To CRFCongenital/Other hereditary diseasesCongenital/Other hereditary diseases

GlomerulonephritisGlomerulonephritis

Cystic kidney diseaseCystic kidney disease

Pyelonephritis & reflux nephropathyPyelonephritis & reflux nephropathy

Renal vascular diseaseRenal vascular disease

Sickle cell diseaseSickle cell disease

Collagen vascularCollagen vascular

Interstitial nephritisInterstitial nephritis

Metabolic diseasesMetabolic diseases

MalignanciesMalignancies

HUS/TTPHUS/TTP

OtherOther

20.2

41.5

5.0

5.8

2.9

0.5

0.5

3.7

0.1

8.3

5.9

2.2

Delaying or halting progression Delaying or halting progression of CRFof CRF

Delaying or halting progression Delaying or halting progression of CRFof CRF

Treatment of the underlying condition if possible

Aggressive blood pressure control to target value

Use of ACE inhibitors as tolerated, with close monitoring for renal deterioration and for hyperkalemia (avoid in advanced renal failure, bilateral renal artery stenosis [RAS], RAS in a solitary kidney)

Aggressive glycemic control in patients with diabetes

Protein restriction - Controversial

Treatment of hyperlipidemia

Avoidance of nephrotoxins - IV radiocontrast, nonsteroidal anti-inflammatory agents, aminoglycosides

Signs and symptoms of chronic Signs and symptoms of chronic renal failurerenal failure

- growth retardation

- anemia

- metabolic acidosis

- hypertension

- anorexia

- lethargy

- electrolyte disorders

Treatment of growth failureTreatment of growth failure

- vitamin alpha-D3

- calcium

- sodium bicarbonate

-growth hormone

Signs and symptoms of chronic Signs and symptoms of chronic renal failurerenal failure

- growth retardation

- anemia

- metabolic acidosis

- hypertension

- anorexia

- lethargy

- electrolyte disorders

Anemia treatmentAnemia treatment

- Iron

- Erythropoietin

- Folic acid

- Vitamin B12

Treating pathologic Treating pathologic manifestations of ESRDmanifestations of ESRD

Treating pathologic Treating pathologic manifestations of ESRDmanifestations of ESRD

Erythropoietin (IV or SC)Iron (PO or IV)Dietary phosphate binders and dietary phosphate restriction Calcium supplementsCalcitriol or vitamin D analogs Oral alkali supplementation Growth hormone (SC, daily)Vitamins ( group B, folic acid)Aggressive blood pressure control (often more than one drug)Kayexalate

Treatment uremic manifestations with chronic renal replacement therapy (hemodialysis, peritoneal dialysis, or renal transplantation).

Indications include severe metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable volume overload, failure to thrive and malnutrition, peripheral neuropathy, intractable gastrointestinal symptoms, and GFR less than 10 cc/min

Replacement Therapy

Dialysis Peritoneal Hemodialysis

Transplant Living Donor

Related Unrelated

Cadaveric Donor

HemodialysisHemodialysis

Peritoneal dialysisPeritoneal dialysis

Advantages of PDAdvantages of PD

ABILITY TO PERFORM DIALYSIS TREATMENT AT HOME

TECHNICALLY EASIER THAN H.D. ESPECIALLY IN INFANTS

ABILITY TO LIVE A GREATER DISTANCE FROM MEDICAL CENTER

FREEDOM TO ATTEND SCHOOL AND AFTER

LESS RESTRICTIVE DIET

LESS EXPENSIVE THAN H.D.

Disadvantages of PDDisadvantages of PD

CATHETER MALFUNCTION

CATHETER RELATED INFECTIONS

NEGATIVE BODY IMAGE

IMPAIRED APPETITE