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Can we slow the progression of chronic kidney disease?

Elke Wühl1, Franz Schaefer

  • 1Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany. elke.wuehl@med.uni-heidelberg.de

Current Opinion in Pediatrics
|January 1, 2010
PubMed

Insights

Pharmacological interventions can significantly slow chronic kidney disease progression in children. Blocking the renin-angiotensin system and controlling blood pressure improve renal survival, with other treatments showing promise.

Area of Science:

  • Pediatric Nephrology
  • Pharmacological Intervention
  • Renal Disease Progression

Background:

  • Childhood chronic kidney disease (CKD) often progresses to end-stage renal failure.
  • This progression is largely independent of the initial renal disease.
  • Recent evidence highlights the potential of pharmacological treatments to slow CKD progression.

Purpose of the Study:

  • To review current pharmacological strategies for slowing the progression of chronic kidney disease in children.
  • To emphasize the role of renin-angiotensin system blockade and blood pressure control.
  • To explore emerging renoprotective therapies.

Main Methods:

  • Review of recent clinical trials and pediatric evidence.
  • Analysis of risk factors for renal disease progression.
  • Evaluation of pharmacological interventions including renin-angiotensin system blockade, blood pressure control, and other agents.

Main Results:

  • Hypertension and proteinuria are key independent risk factors for CKD progression.
  • Renin-angiotensin system blockade effectively controls blood pressure and proteinuria, offering superior renoprotection.
  • Tight blood pressure control in children can improve 5-year renal survival by 35%.

Conclusions:

  • Pharmacological renoprotection in pediatric CKD primarily involves antihypertensive and antiproteinuric treatments via renin-angiotensin system blockade.
  • Intensified blood pressure control significantly enhances renal survival.
  • Complementary strategies like correcting metabolic acidosis and hyperuricemia, and using antiproliferative/antioxidative drugs show future potential.
Abstract

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