Chronic Kidney Disease in Children and Adolescents Susan F. Massengill, MD,* Maria Ferris, MD, MPH, PhD † Author Disclosure Drs Massengill and Ferris have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/ device. Educational Gap Chronic kidney disease (CKD) is a devastating diagnosis with many co-morbidities, in- creasing the risk of mortality 30 to 150 times that of the general pediatric population. Recognition of at-risk children can lead to earlier screening and risk reduction. Primary care clinicians are often unaware of the comorbid conditions and long-term consequen- ces of CKD, particularly with respect to cardiovascular disease, nutrition and growth, neurocognitive development, and burden of disease. Objectives After completing this article, readers should be able to: 1. Be aware of the life course of CKD and its co-morbidities. 2. Recall the risk factors and complications of pediatric CKD. 3. Discuss measures to prevent or delay the progression of pediatric CKD. 4. Optimize the communication between the primary care clinician and nephrologist in treating children, adolescents, and young adults with CKD. Case 1 A 13-month-old toddler new to your practice presents for his 1-year health maintenance visit with poor growth and developmental delay. He is just now sitting without support and appears to have occasional leg pain. He is pale, weighs 7.9 kg, and has a normal blood pressure. The results of laboratory studies are remarkable for anemia (hemoglobin, 9 g/dL [90 g/L]), profound acidosis (carbon dioxide, 12 mEq/L [12 mmol/L]), azotemia (urea nitrogen, 117 mg/dL [41.8 mmol/L]; creatinine, 2.44 mg/dL [216 mmol/L]), and profound hypocalcemia (calcium, 5.6 mg/dL [1.40 mmol/L]), prompting further evalu- ation where hypocalcemia was confirmed. Urinalysis revealed a specific gravity of 1.005 and proteinuria (1þ). Renal ultrasonography revealed bilateral renal hypoplasia. Renal replace- ment therapy was initiated with peritoneal dialysis, and the patient is on the renal transplan- tation waiting list. Case 2 A previously healthy, 14-year-old, African American girl presents with a 3-month history of facial and lower-extremity rash and a 4.5-kg weight loss. Her medical history is unre- markable for contributing conditions. She denies sexual ac- tivity, travel, pet ownership, or tick exposure. Her family history is positive for type 1 diabetes mellitus in a younger brother and hypothyroidism in her mother. On physical ex- amination, she is hypertensive (blood pressure, 150/90 mm Hg), with a malar erythematous rash and palpable pur- pura on the lower extremities. Laboratory studies reveal the following: serum creatinine, 2.5 mg/dL (221 mmol/L); esti- mated glomerular filtration rate (eGFR), 34 mL/min/1.73 m 2 ; urea nitrogen, 75 mg/dL (26.8 mmol/L); and positive Abbreviations 1,25(OH)2 D: 1,25-dihydroxyvitamin D ACE: angiotensin-converting enzyme CKD: chronic kidney disease CKiD: Chronic Kidney Disease in Children CVD: cardiovascular disease eGFR: estimated glomerular filtration rate ESKD: end-stage kidney disease GFR: glomerular filtration rate HCT: health care transition MBD: metabolic bone disease *Director, Pediatric Nephrology, Levine Children’s Hospital, Adjunct Associate Professor of Pediatrics, University of North Carolina School of Medicine, Charlotte, NC. † Director, Pediatric Dialysis and Transplant Programs, UNC Kidney Center, Founder and Director, The UNC Children’s Hospital TR x ANSITION Program, University of North Carolina at Chapel Hill, Chapel Hill, NC. Article nephrology 16 Pediatrics in Review Vol.35 No.1 January 2014 at Walter Reed Army Med Ctr on March 4, 2014 http://pedsinreview.aappublications.org/ Downloaded from