The criteria for the definition of chronic kidney disease (CKD) in children include: (a) kidney damage for >3 months, as defined by structural or functional abnormalities determined by kidney biopsy, imaging tests or composition of the blood or urine, with or without decreased GFR; and (b) GFR <60 ml/min/1.73 m2 for ≥3 months, with or without the signs of kidney damage listed above [1]. The prevalence of CKD was as high as 11% in the adult population. 4.7% of the adult population from one study had a glomerular filtration rate (GFR) <60 ml/min (stages 3–5) [2]. Similar studies showed a higher prevalence (5.1%) of known stages 3–5 CKD in the general population, based on analysis of single serum creatinine results held on general practitioners computers [3]. The prevalence and epidemiological information on pediatric CKD is currently imprecise and flawed by methodological differences between the various data sources. The long-term survival of children with end-stage renal disease has improved in the last 25 years but the mortality is still very high, about 30 times as high as expected for age [4].

James F. Goodhart, a nephrologist succeeding Richard Bright at Guy’s Hospital in London, provided one of the first historic descriptions of CKD in children. “The first point I will insist upon is the frequency with which serious disease of the kidney fails in symptoms. It may be possible to overlook very chronic cases in children by reason of this very absence of symptoms” [5]. Indeed, many children with CKD do not manifest clinically until their renal failure is advanced. CKD in children is the result of heterogenous diseases of the kidney and urinary tract that range from congenital malformations to rare inborn errors of metabolism. Not only is the spectrum of underlying causes of CKD very different in children compared with adults, the symptoms and pathophysiology are confounded by unique factors in the young and growing body. Thus, CKD in children requires a greater amount of resources, specialized care and time in order to achieve early detection and optimal outcomes. The challenges facing physicians treating children with CKD are compounded by the need to pay close attention to growth, development and social maturation.

In a series of educational features starting in this issue of the journal, we have invited international experts to provide state-of-the-art summaries of the current knowledge and treatment guidelines for the care of children with CKD. To start, Lesley Rees will provide an up-to-date review on nutrition in CKD [6] and Debbie Gipson will educate us on a relatively understudied subject, which is the central nervous system in CKD [7]. One of the global initiatives on CKD is early detection. In this respect, George Schwartz and Susan Furth will discuss “Methods for measuring GFR in CKD” [8] and Kevin Lemley will discuss “Biomarkers for CKD”. As congenital and developmental disorders distinguish pediatric CKD from the adult spectrum, Bradley Warady will discuss “Epidemiology of CKD in children” and Scott Satko will discuss “Genetics factors in CKD”. The very interesting topic of renal disease progression will be explored in depth by two experts in the field. Agnes Fogo will summarize the current knowledge on “Mechanisms of progression” and Franz Schaefer will review the “Therapeutic strategies to slow progression”. Then several articles on complications of CKD will follow, such as Denis Geary on anemia, Mark Mitsnefes on cardiovascular complications, Isidro Salusky on osteodystrophy, Frederick Kaskel on growth disorders, and Uwe Querfeld on hyperlipidemia. Advances in therapy will be highlighted with a series of articles. Craig Wong will present “The team approach to the management of CKD”, Susan Ridgen will review “Management of the infant with CKD”, and David Rozansky will discuss “Treatment of hypertension in CKD”. Last but certainly not least, Sangeeta Hingorani will explore CKD in the context of children after transplantation.

It is recognized that the bulk of the current information and guidelines is based mostly on opinion and inconclusive data from small under-powered studies. However, large multi-center well-designed studies such as the chronic kidney disease in children (CkiD) prospective cohort study [9] and the ESCAPE (Effect of Strict blood pressure Control and Angiotensin converting enzyme inhibition on progression of CKD in PEdiatric patients) interventional trial [10] are underway and will hopefully provide evidence-based recommendations for the care of children with CKD in the near future.