The Indian Journal of Pediatrics

, Volume 66, Issue 2, pp 241–253

Evaluation and treatment of chronic renal failure

Symposium: Pediatric Nephrology


Chronic renal failure (CRF) is the irreversible deterioration of renal function that gradually progresses to end stage renal disease (ESRD). The chief causes of CRF include obstructive uropathy, primary glomerular diseases, reflux nephropathy and hypoplastic or dysplastic kidneys. Progressive hyperperfusion and hyperfiltration causes increasing glomerular injury and further renal damage. Symptoms of CRF are usually seen when GFR is between 10–25% of normal. Children with severe CRF often suffer from failure to thrive, growth retardation, acidosis, anemia and renal osteodystrophy. Management of CRF aims at retarding progression of renal damage and treatment of complications related to renal dysfunction. Measures suggested to retard progression include protein restriction, strict control of hypertension, use of angiotensin converting enzyme inhibitors and control of hyperlipidemia. Appropriate amounts of protein and calories are recommended to prevent growth failure. Nutritional supplements are often required. The availability of recombinant erythropoietin, calcitriol and human growth hormone has significantly improved the management of these patients. Once ESRD supervenes, renal replacement therapy in the form of chronic peritoneal or hemodialysis and transplantation is necessary.

Key words

End stage renal disease Urinary tract obstruction Nutrition Peritoneal dialysis Hemodialysis 


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  1. 1.
    North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) 1998 annual report: Renal transplantation, Dialysis and Chronic Renal Insufficiency 1998; p 13–3.Google Scholar
  2. 2.
    Brenner BM, Lawler EV, Mackenzie HS. The hyperfiltration theory: A paradigm shift in nephrology.Kidney Int 1996; 49: 1774.PubMedCrossRefGoogle Scholar
  3. 3.
    Klahr S, Levery AS, Beck GJet al. The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease.N Engl J Med 1994; 330: 877–884.PubMedCrossRefGoogle Scholar
  4. 4.
    Ketteler M, Noble NA, Border W. Transforming growth facor-beta and angiotensin II: The missing link from glomerular hypertrophy to glomerulosclerosis?Ann Rev Physiol 1995; 57: 279–295.CrossRefGoogle Scholar
  5. 5.
    Floege J, Johnsaon RJ. Multiple roles for platelet-derived growth factors in renal disease.Miner Elctrolyte Metab 1995; 21: 279–295.Google Scholar
  6. 6.
    Hostetter TH. The paradox of the reninangiotensin system in chronic renal disease.Kidney Int 1992; 42: 452–458.CrossRefGoogle Scholar
  7. 7.
    Blazy I, Dechaux M, Charbit Met al. Endothelin-1 in children with renal failure.Pediatr Nephrol 1994; 8: 40–47.PubMedCrossRefGoogle Scholar
  8. 8.
    Levey AS. Nephrology Forum: Measurement of renal function in chronic renal disease.Kedney Int 1990; 38: 167–184.CrossRefGoogle Scholar
  9. 9.
    Martin MMC, Cuevas LOL, Bustamante J. Purification and analysis of plasmatic components of middle molecular weight in patients with uremic syndrome.Nephron 1995; 71: 160–167.CrossRefGoogle Scholar
  10. 10.
    Kovalik CK. Endocrine Manifestations of Renal Failure. In: Greenberg A (Ed)Primers on Kidney Disease; 2nd edition. Academic Press, San Diego, 1998; pp 472–476.Google Scholar
  11. 11.
    Rit E, Stefanski A, Rambausek M. The role of the parathyroid glands in the uremic syndrome.Am J Kid Dis 1995; 26: 808–813.Google Scholar
  12. 12.
    White PC. Disorders of aldosterone biosynthesis and action.New Eng J Med 1994; 331: 250–258.PubMedCrossRefGoogle Scholar
  13. 13.
    Dabbagh S. Renal osteodystrophy.Curr Opin Pediatr 1998; 10: 190–196.PubMedCrossRefGoogle Scholar
  14. 14.
    Ma JZ, Greene EL, Raij L. Cardiovascular risk factors in chronic renal failure and hemodialysis population.Am J Kid Dis 1996; 27: 652–663.Google Scholar
  15. 15.
    Ravelli AM. Gastrointestinal function in chronic renal failure.Pediatr Nephrol 1995; 9: 756–762.PubMedCrossRefGoogle Scholar
  16. 16.
    Viagno G, Remuzzi G. Bleeding time in uremia.Semin Dialysis 1996; 9: 34–38.CrossRefGoogle Scholar
  17. 17.
    Livio M, Bengini A, Remuzzi G. Coagulation abnormalities in uremia.Semin Nephrol 1985; 5: 82–90.PubMedGoogle Scholar
  18. 18.
    Lewis SL. Van Epps DE. Neutrophil and monocyte alterations in chronic dialysis patients.Am J Kid Dis 1987; 9: 381–395.PubMedGoogle Scholar
  19. 19.
    Uysal S, Reuda Y, Saatci U, Yalez K, Neurologic complications in chronic renal failure: a retrospective study.Clin Pediatr 1990; 29: 510–514.CrossRefGoogle Scholar
  20. 20.
    Polinsky MS, Kaiser BA, Stover JB, Frankenfield M, Baluarte HJ. Neurologic development of children with chronic renal failure from infancy.Pediatr Nephrol 1987; 1: 157–165.PubMedCrossRefGoogle Scholar
  21. 21.
    Andreoli SP, Bergstein JM, Sherrard DJ. Aluminium intoxication from aluminium containing phosphate binders in children with azotemia not undergoing dialysis.N Eng J Med 1984; 310: 1079–1084.CrossRefGoogle Scholar
  22. 22.
    Tagge EP, Campbell DA, Dafoe DCet al. Pediatric renal transplantation with an emphasis on the progression of patients with chronic renal insufficiency since infancy.Surgery 1987; 102: 692–698.PubMedGoogle Scholar
  23. 23.
    Powell DR. Effects of renal failure on the growth hormone-insulin like growth factor axis.J Pediatr 1997; 131: S13-S16.PubMedCrossRefGoogle Scholar
  24. 24.
    Ahmed KR, Kopple JD. Nutrition in maintenance hemodialysis patients. In: Kopple JD, Massry SG (eds).Nutritional Management of Renal Disease. William and Wilkins, Baltimore, MD 1996, pp 563–600.Google Scholar
  25. 25.
    Levery AS, Adler S, Caggiula AWet al. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study.Am J Kidney Dis 1996; 27: 652–663.Google Scholar
  26. 26.
    Maschio G, Alberti D, Janin Get al. Effect of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study.Am J Kidney Dis 1996; 27: 652–663.Google Scholar
  27. 27.
    Bergisio F, Monzani G, Cinti Ret al. Lipids and apolipoproteins change during the progression of chronic renal failure.Clin Nephrol 1992; 38: 264–270.Google Scholar
  28. 28.
    Erslev AJ. Erythropoietin.N Eng J Med 1991; 324: 1339–1343.CrossRefGoogle Scholar
  29. 29.
    Fishbane S, Maesaka JK. Iron management in end-stage renal disease.Am J Kidney Dis 1997; 29: 319–333.PubMedGoogle Scholar
  30. 30.
    Townsend RR, Cirigiliano M. Hypertension in renal failure.Disease-a-month 1998; 44: 243–253.PubMedCrossRefGoogle Scholar
  31. 31.
    Andress DL, Keith MD, Norris Cet al. Intravenous calcitriol in the treatment of refractory osteitis fibrosa of chronic renal failure.N Engl J Med 1989; 321: 274–279PubMedCrossRefGoogle Scholar
  32. 32.
    Lindberg JS, Moore J, and Martin KJ. 19-nor safely and effectively reduces iPTH levels in hemodialysis patients.J Am Soc Nephrol 1997; 8: A2685.Google Scholar
  33. 33.
    Mehls O, Tonshoff B, Haffner D, Wahl E, Schaefer F. The use of recombinant growth hormone in short children with chronic renal failure.J Pediatr Endocrinol 1994; 7: 107–113.PubMedGoogle Scholar
  34. 34.
    Menster M, Breen TJ, Sullivan EK and Fine RN. Growth-hormone treatment of renal transplant recipient: The National Cooperative Growth Study experience-a report of the National Cooperative Growth Study and the North American Pediatric Renal Transplant Cooperative Study.J Pediatr 1997; 131: S20-S24.CrossRefGoogle Scholar
  35. 35.
    Huysmans K, Lins RL, Daelemans R, Zachee P, DeBroe ME. Hypertension and accelerated athrosclerosis in end stage renal disease.J Nephrol 1998; 11: 185–195.PubMedGoogle Scholar
  36. 36.
    Canada-USA (CANUSA) Peritoneal Diaylsis Study Group: Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes.J Am Soc Nephrol 1996; 198–207.Google Scholar
  37. 37.
    Held PJ, Port FK, Wolfe RA,et al. The dose of hemodialysis and patient mortality.Kid Int 1996; 50: 550–556.CrossRefGoogle Scholar
  38. 38.
    Khattak S, Rogan JW, Saunders EF, Theis JGW, Arbus GS, Koren G. Efficacy of amilodipine in pediatric bone marrow transplant recipients.Clin Pediatr 1998; 37: 31–36.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 1999

Authors and Affiliations

  1. 1.Department of PediatricsCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of PediatricsAll India Institute of Medical SciencesNew Delhi

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