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Chronic Kidney Disease in Children: Risk-Based Stratification and Treatment

  • Pediatric Nephrology (BP Dixon and E Nehus, Section Editors)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Abstract

Purpose of review

This paper provides a review of the epidemiology, classification, risk-based stratification, and identification of traditional and novel risk factors for chronic kidney disease (CKD) progression in children. Current treatment strategies designed to halt progression and best practices regarding vascular access preservation are discussed.

Recent findings

Substantial progress in CKD diagnosis has been made, particularly in the refinement of glomerular filtration rate (GFR) estimating equations in children. A number of new risk factors for CKD progression are described, including genetic underpinnings of CKD. Efforts designed to risk-stratify those children at highest risk for progression to ESRD and to define modifiable risk factors have been undertaken by collaborative research initiatives.

Summary

The management of pediatric CKD comprises appropriate diagnosis and classification of CKD severity through the use of updated eGFR estimating equations, and amelioration of existing risk factors for progression. The most important factors, hypertension and proteinuria, are validated endpoints for treatment with medications that target renin-angiotensin-aldosterone system blockade. Optimal blood pressure management is also essential to limit the frequency of cardiovascular disease. Several multicenter collaborative studies have shed light on the myriad of comorbidities experienced by children with CKD, in addition to elucidating risk determinants for CKD progression.

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Authors and Affiliations

  1. Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Section of Pediatric Nephrology, Children’s Mercy, Kansas City, MO, USA

    Darcy K. Weidemann MD, MHS & Bradley A. Warady MD

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Weidemann, D.K., Warady, B.A. Chronic Kidney Disease in Children: Risk-Based Stratification and Treatment. Curr Treat Options Peds 5, 45–60 (2019). https://doi.org/10.1007/s40746-019-00150-x

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