Chronic renal failure in children

Chronic renal failure in children is a non-specific 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 renal failure.
• N18.8. Other manifestations of chronic renal failure.
• N18.9. Chronic renal failure, unspecified.

Epidemiology

According to literature data, the incidence of chronic renal failure among children is 3-50 per 1,000,000 children. Every year, 4-6 people out of 1,000,000 patients under the age of 15 require the start of renal replacement therapy due to chronic renal 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 course of nephropathy;
• early decline in renal function;
• renal dysembryogenesis;
• increasing instability of cell membranes;
• influence of drugs.

The risk group for developing chronic renal failure includes patients suffering from:

• tissue renal dysembryogenesis;
• severe uropathy;
• tubulopathies;
• hereditary nephritis;
• sclerosing variants of nephritis.

Causes of Chronic Renal Failure

How does chronic renal failure develop in children?

It has been established that in most patients with SCF of about 25 ml/min and below, terminal chronic renal failure inevitably occurs, regardless of the nature of the disease. There is an adaptive response of intrarenal hemodynamics to the loss of mass of functioning nephrons: a decrease in resistance in the afferent (more pronounced) and efferent arterioles of functioning nephrons, leading to an increase in the rate of intraglomerular plasma flow, i.e. to hyperperfusion of the glomeruli and an increase in hydraulic pressure in their capillaries.

Pathogenesis of chronic renal failure

Symptoms of Chronic Kidney Failure in Children

In the initial stage of chronic renal failure, patients' complaints and clinical symptoms may be largely associated with the underlying disease. Unlike acute renal failure, chronic renal failure develops gradually. The clinical picture often develops with a SCF of less than 25 ml/min. Complications, damage to other organs and systems in chronic renal 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. The latter are: the value of glomerular filtration, the concentration of serum creatinine, the dysfunction of the tubules 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.

• Medical history: presence and duration of proteinuria, arterial hypertension, delayed physical development, recurrent urinary tract infection, etc.
• Family history: indications of polycystic disease, Alport syndrome, systemic connective tissue diseases, etc.
• Objective examination: growth retardation, underweight, skeletal deformities, signs of anemia and hypogonadism, increased blood pressure, pathology of the fundus, decreased hearing acuity, etc.

Diagnosis of chronic renal failure

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

Treatment of chronic renal failure in children

Before starting treatment of a patient with chronic renal failure, 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 renal dysfunction. An unambiguous interpretation of these important indicators is considered important for the management tactics, and therefore the use of the same terminological and diagnostic approaches.

Patients with chronic renal failure require dietary correction and syndrome treatment.

How is chronic renal failure treated?

Prevention of chronic renal failure in children

Measures to prevent sclerosis of the renal parenchyma and a decrease in 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 assessment of progression factors.

Forecast

Each of the methods of renal replacement therapy has a certain survival period, and transplantation is also considered not the final stage of treatment, but only one of the stages. After the loss of transplant function, it is possible to return to peritoneal dialysis or, in case of loss of peritoneal function, to hemodialysis with subsequent re-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 the mortality rate among children receiving dialysis is 30-150 times higher than in the general population. At the present stage, the expected life expectancy for a child who began receiving 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 aimed at primary prevention, early diagnosis and active treatment at all stages.

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