eMedicine Specialties > Pediatrics: General Medicine > Nephrology

Chronic Kidney Disease: Follow-up

Author: Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada), Associate Professor, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Senior Consultant in Pediatric Nephrology, Department of Nephrology and Transplant Medicine, Fortis Hospitals, India
Contributor Information and Disclosures

Updated: Aug 12, 2009

Follow-up

Further Outpatient Care

  • All children require regular follow-up on an outpatient basis in a dedicated chronic kidney disease (CKD) clinic until initiation of long-term renal replacement therapy. This involves a multidisciplinary team approach that involves the nephrologist, primary care physician, renal dietitian, nurse, and social worker. They should work in close coordination with the primary pediatrician or family physician.

Transfer

  • Patients with any complications require transfer to a center with a pediatric nephrology unit where acute dialysis can be performed if required.

Prognosis

  • Once chronic kidney disease occurs, progression to end-stage renal disease (ESRD) appears certain. However, the rate of progression depends on the underlying diagnosis, on the successful implementation of secondary preventive measures, and on the individual patient.
  • Once the estimated glomerular filtration rate (eGFR) declines to less than 30 mL/min per 1.73 m2 and the child has stage IV chronic kidney disease, the child and the family should be prepared for renal replacement therapy. The family should be provided with information related to preemptive kidney transplantation, peritoneal dialysis, and hemodialysis. When preemptive transplantation is not an option, the choice between the 2 forms of dialysis is generally dictated by technical, social, and compliance issues, as well as family preference. Peritoneal dialysis is much more common in infants and younger children.
  • Patients on long-term dialysis have a high incidence of morbidity and mortality.
  • Preemptive renal transplantation should be the goal of management in these children.

Patient Education

  • Children with chronic kidney disease and their families should receive education about the importance of compliance with secondary preventative measures, natural disease progression, prescribed medications (highlighting their potential benefits and adverse effects), diet, and types of long-term renal replacement modalities.
  • For excellent patient education resources related to kidney disease, visit eMedicine's Kidneys and Urinary System Center. These resources may be printed free of charge.

Miscellaneous

Medicolegal Pitfalls

  • Some medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents are contraindicated in children with chronic kidney disease (CKD) because of the risk of deterioration of kidney function. Dose modification is required for a wide variety of drugs belonging to different categories.
  • Unexplained anemia or short stature is sometimes the only presentation in a child. A high index of suspicion is required for early diagnosis.
 


More on Chronic Kidney Disease

Overview: Chronic Kidney Disease
Differential Diagnoses & Workup: Chronic Kidney Disease
Treatment & Medication: Chronic Kidney Disease
Follow-up: Chronic Kidney Disease
Multimedia: Chronic Kidney Disease
References
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References

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  2. [Guideline] Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. Jan 2001;37(1 Suppl 2):S66-70. [Medline].

  3. [Guideline] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. Feb 2002;39(2 Suppl 1):S1-266. [Medline].

  4. [Guideline] KDOQI. KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Executive summary. Am J Kidney Dis. Mar 2009;53(3 Suppl 2):S11-104. [Medline].

  5. Seikaly MG, Ho PL, Emmett L, et al. Chronic renal insufficiency in children: the 2001 Annual Report of the NAPRTCS. Pediatr Nephrol. Aug 2003;18(8):796-804. [Medline].

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  7. Ardissino G, Dacco V, Testa S, et al. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. Apr 2003;111(4 Pt 1):e382-7. [Medline].

  8. Craven AM, Hawley CM, McDonald SP, et al. Predictors of renal recovery in Australian and New Zealand end-stage renal failure patients treated with peritoneal dialysis. Perit Dial Int. Mar-Apr 2007;27(2):184-91. [Medline].

  9. [Best Evidence] Choi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Hernandez GT, O'Hare AM. White/black racial differences in risk of end-stage renal disease and death. Am J Med. Jul 2009;122(7):672-8. [Medline].

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Further Reading

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Keywords

chronic kidney disease, CKD, end-stage renal disease, ESRD, end-stage kidney disease, ESKD, chronic renal disease, CRD, chronic renal insufficiency, CRI, adaptive hyperfiltration, end-stage kidney failure, proteinuria, progressive kidney insufficiency, anemia, osteodystrophy, systemic hypertension, intraglomerular hypertension, glomerular hypertrophy, metabolic acidosis, hyperlipidemia, tubulointerstitial disease, systemic inflammation, altered prostanoid metabolism, cardiac arrest, myocardial ischemia, pulmonary edema, hyperkalemia, obstructive uropathy, polydipsia, nocturia, treatment, diagnosis

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Contributor Information and Disclosures

Author

Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada), Associate Professor, Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences; Senior Consultant in Pediatric Nephrology, Department of Nephrology and Transplant Medicine, Fortis Hospitals, India
Sanjeev Gulati, MBBS, MD, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada) is a member of the following medical societies: American Society of Pediatric Nephrology, Indian Academy of Pediatrics, International Society of Nephrology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Laurence Finberg, MD, Clinical Professor, Department of Pediatrics, University of California at San Francisco and Stanford University
Laurence Finberg, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Frederick J Kaskel, MD, PhD, Director of the Division and Training Program in Pediatric Nephrology, Vice Chair, Department of Pediatrics, Montefiore Medical Center and Albert Einstein School of Medicine
Frederick J Kaskel, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, American Physiological Society, American Society of Nephrology, American Society of Pediatric Nephrology, American Society of Transplantation, Eastern Society for Pediatric Research, Federation of American Societies for Experimental Biology, International Society of Nephrology, National Kidney Foundation, New York Academy of Sciences, Renal Physicians Association, Sigma Xi, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Howard Trachtman, MD, Program Director, Pediatrics Research, Schneider Children's Hospital, Department of Pediatrics, Division of Nephrology, Professor, Albert Einstein College of Medicine
Howard Trachtman, MD is a member of the following medical societies: American Society of Hypertension, American Society of Nephrology, American Society of Pediatric Nephrology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Craig B Langman, MD, The Isaac A Abt, MD, Professor of Kidney Diseases, Feinberg School of Medicine, Northwestern University; Division Head of Kidney Diseases, Children's Memorial Hospital, Chicago
Craig B Langman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Nephrology, and International Society of Nephrology
Disclosure: Amgen Grant/research funds None; Altus Pharmaceuticals Grant/research funds None; Genzyme Grant/research funds None; Merck Grant/research funds None; NIH Grant/research funds None

 
 
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