Pediatric Nephrologist and the Infant or Child Before Kidney Transplantation

  • Christopher LaRosa
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Renal transplantation is the standard of care for the management of pediatric end-stage renal disease. Many infants, children, and adolescents require dialysis prior to transplant, and due to this therapeutic modality, transplant is considered elective. However, significant short-term and long-term morbidities are associated with dialysis, especially when necessary for prolonged periods. For this reason, preemptive renal transplant is desirable when it can be planned. Most chronic kidney disease and end-stage renal disease in pediatrics is due to congenital structural abnormalities, although the predominant causes of renal disease vary by age, geography, and ethnicity. A substantial proportion of pediatric renal disease has a known genetic cause. Effective management of chronic kidney disease, specifically its complications, can have a significant impact on outcomes and potentially delay the onset of end-stage renal disease.


End-stage renal disease Chronic kidney disease Renal replacement therapy Hemodialysis Peritoneal dialysis Hypertension Growth hormone Glomerular filtration rate Congenital abnormalities of the kidney and urinary tract Next-generation sequencing Steroid-resistant nephrotic syndrome Focal segmental glomerulosclerosis Glomerulonephritis Mineral and bone disease Angiotensin-converting enzyme inihibitor Angiotensin receptor blocker 


  1. Abitbol CL, Ingelfinger JR (2009) Nephron mass and cardiovascular and renal disease risks. Semin Nephrol 29(4):445–454.
  2. Amaral S, Sayed BA, Kutner N, Patzer RE (2016) Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Intl 90:1100–1108CrossRefGoogle Scholar
  3. Anavekar NS, Pfeffer MA (2004) Cardiovascular risk in chronic kidney disease. Kidney Int Suppl 92:S11–S15CrossRefGoogle Scholar
  4. ANZDATA Registry (2016) 38th report, paediatrics. Australia and New Zealand dialysis and transplant registry, Adelaide. Chapter 11. Available at:
  5. Ardissino G et al (2012) Puberty is associated with increased deterioration of renal function in patients with CKD: data from the ItalKid project. Arch Dis Child 97:885–888CrossRefPubMedGoogle Scholar
  6. Atkinson MA, Furth SL (2011) Anemia in children with chronic kidney disease. Nat Rev Nephrol 7:635–641CrossRefPubMedPubMedCentralGoogle Scholar
  7. Atkinson MA, Martz K, Warady BA et al (2010) Risk for anemia in pediatric chronic kidney disease patients: a report of NAPRTCS. Pediatr Nephrol 25:1699–1706CrossRefPubMedGoogle Scholar
  8. Becherucci F et al (2016) Chronic kidney disease in children. Clin Kidney J 9(4):583–591CrossRefPubMedPubMedCentralGoogle Scholar
  9. Brenner BM, Lawler EV, Mackenzie HS (1996) The hyperfiltration theory: a paradigm shift in nephrology. Kidney Int 49(6):1774CrossRefPubMedGoogle Scholar
  10. Dahlinghaus EK, Neu AM, Atkinson MA et al (2014) Hemoglobin level and risk of hospitalization and mortality in children on peritoneal dialysis. Pediatr Nephrol 29:2387–2394CrossRefPubMedGoogle Scholar
  11. ESCAPE Trial Group (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361(17):1639–1650. CrossRefGoogle Scholar
  12. Fine RN, Stablein D, Cohen AH, Tejani A, Kohaut E (2002) Recombinant human growth hormone post-renal transplantation in children: a randomized controlled study of the NAPRTCS. Kidney Int 62(2):688CrossRefPubMedGoogle Scholar
  13. Flynn JT, Mitsnefes M, Pierce C, Cole SR, Parekh RS, Furth SL, Warady BA, Chronic Kidney Disease in Children Study Group (2008) Blood pressure in children with chronic kidney disease: a report from the chronic kidney disease in children study. Hypertension 52(4):631–637. Epub 2008 Aug 25
  14. Fogo AB (2007) Mechanisms of progression of chronic kidney disease. Pediatr Nephrol 22(12):2011CrossRefPubMedPubMedCentralGoogle Scholar
  15. Gerson A, Hwang W, Fiorenza J et al (2004) Anemia and health-related quality of life in adolescents with chronic kidney disease. Am J Kidney Dis 44:1017–1023CrossRefPubMedGoogle Scholar
  16. Gillen DL, Stehman-Breen CO et al (2008) Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant 8(12):2600–2606CrossRefPubMedGoogle Scholar
  17. Goldstein SL, Gerson AC, Goldman CW, Furth S (2006) Quality of life for children with Chronic Kidney Disease. Semin Nephrol 26(2):114–117CrossRefPubMedGoogle Scholar
  18. Harambat J et al (2012) Epidemiology of chronic kidney disease in children. Pediatr Nephrol 27(3):363–373CrossRefPubMedGoogle Scholar
  19. Hart A et al (2017) OPTN/SRTR 2015 annual data report: kidney. Am J Transplant 17(Suppl S1):1–564Google Scholar
  20. Hodson EM, Willis NS, Craig JC (2012) Growth hormone for children with chronic kidney disease. Cochrane Database Syst Rev 15:CD003264Google Scholar
  21. Kidney Disease: Improving Global Outcomes (KDIGO) CKD work group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150CrossRefGoogle Scholar
  22. Kurella Tamura M, Vittinghoff E, Yang J et al (2016) Anemia and risk for cognitive decline in chronic kidney disease. BMC Nephrol 17:13CrossRefPubMedPubMedCentralGoogle Scholar
  23. Menon S, Kirkendall ES, Nguyen H, Goldstein SL (2014) Acute kidney injury associated with high nephrotoxic medication exposure leads to chronic kidney disease after 6 months. J Pediatr 165(3):522–527.e2. Epub 2014 Jun 11; Ding W, Cheung WW, Mak RH (2015) Impact of obesity on kidney function and blood pressure in children. World J Nephrol 4:223–229
  24. Mitsnefes MM (2012) Cardiovascular disease in children with chronic kidney disease. J Am Soc Nephrol 23:578–585CrossRefPubMedPubMedCentralGoogle Scholar
  25. Mitsnefes MM, Kimball TR, Kartal J et al (2006) Progression of left ventricular hypertrophy in children with early chronic kidney disease: 2-year follow-up study. J Pediatr 149:671–675CrossRefPubMedGoogle Scholar
  26. Mitsnefes M, Flynn J, Cohn S et al (2010) Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol 21:137CrossRefPubMedPubMedCentralGoogle Scholar
  27. Moosa MR, Kidd M (2006) The dangers of rationing dialysis treatment: the dilemma facing a developing country. Kidney Int 70:1107–1114CrossRefPubMedGoogle Scholar
  28. National Institute of Diabetes and Digestive and Kidney Diseases (2010) Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, BethesdaGoogle Scholar
  29. Ng D et al (2017) APOL1 -associated glomerular disease among African-American children: a collaboration of the Chronic Kidney Disease in Children (CKiD) and Nephrotic Syndrome Study Network (NEPTUNE) cohorts. Nephrol Dial Transpl 32(6):983–990Google Scholar
  30. Panwar B, Gutierrez OM (2016) Disorders of iron metabolism and anemia in chronic kidney disease. Sem Nephrol 36:252–261CrossRefGoogle Scholar
  31. Parsa A, Kao WH, Xie D, Astor BC, Li M, Hsu CY, Feldman HI, Parekh RS, Kusek JW, Greene TH, Fink JC, Anderson AH, Choi MJ, Wright JT Jr, Lash JP, Freedman BI, Ojo A, Winkler CA, Raj DS, Kopp JB, He J, Jensvold NG, Tao K, Lipkowitz MS, Appel LJ, AASK Study Investigators, CRIC Study Investigators (2013) APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med 369(23):2183Google Scholar
  32. Rees L, Shroff R (2015) The demise of calcium-based phosphate binders-is this appropriate for children? Pediatr Nephrol 30:2061–2071CrossRefPubMedGoogle Scholar
  33. Rodig NM et al (2014) Growth in children with chronic Kidney disease: a report from the Chronic Kidney Disease in Children Study. Pediatr Nephrol 29:1987–1995CrossRefPubMedPubMedCentralGoogle Scholar
  34. Schreuder MF (2012) Safety in glomerular numbers. Pediatr Nephrol 27(10):1881–1887. Epub 2012 Apr 25
  35. Shroff R, Dégi A, Kerti A et al (2013) Cardiovascular risk assessment in children with chronic kidney disease. Pediatr Nephrol 28:875–884CrossRefPubMedGoogle Scholar
  36. Staples AM et al (2010) Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol 5(12):2172–2179. Epub 2010 Sep 2CrossRefPubMedPubMedCentralGoogle Scholar
  37. Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW (2016) Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 31(10):1579CrossRefPubMedGoogle Scholar
  38. Tonelli M, Wiebe N et al (2011) Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 11(10):2093–2109CrossRefPubMedGoogle Scholar
  39. Van Arendonk KJ et al (2014) National trends Over 25 years in pediatric kidney transplant outcomes. Pediatrics 133(4):594–601CrossRefPubMedPubMedCentralGoogle Scholar
  40. Verrina E (2009) Peritoneal dialysis. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N (eds) Pediatric nephrology. Springer, Berlin/Heidelberg, p 1785CrossRefGoogle Scholar
  41. Vivante A, Hildebrandt F (2016) Exploring the genetic basis of early-onset chronic kidney disease. Nat Rev Nephrol 12:133–146CrossRefPubMedPubMedCentralGoogle Scholar
  42. Warady BA, Chadha V (2007) Chronic kidney disease in children: the global perspective. Pediatr Nephrol 22:1999–2009CrossRefPubMedPubMedCentralGoogle Scholar
  43. Warady BA, Abraham AG, Schwartz GJ, Wong CS, Muñoz A, Betoko A, Mitsnefes M, Kaskel F, Greenbaum LA, Mak RH, Flynn J, Moxey-Mims MM, Furth S (2015) Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: the chronic kidney disease in children (CKiD) cohort. Am J Kidney Dis 65(6):878; Fathallah-Shaykh SA, Flynn JT, Pierce CB, Abraham AG, Blydt-Hansen TD, Massengill SF, Moxey-Mims MM, Warady BA, Furth SL, Wong CS (2015) Clin J Am Soc Nephrol 10(4):571Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

Section editors and affiliations

  • J Jeffrey Malatack
    • 1
  1. 1.Diagnostic Referral DivisionNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

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