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Urologic Considerations in Pediatric Chronic Kidney Disease

Rebecca M Lombel1, Paul R Brakeman2, Bryan S Sack3

  • 1Division of Pediatric Nephrology, University of Michigan, Ann Arbor, MI.

Advances in Chronic Kidney Disease
|September 9, 2022
PubMed

Insights

Congenital anomalies of the kidney and urinary tract (CAKUT) are leading causes of pediatric end-stage renal disease (ESRD). Understanding CAKUT is crucial for adult nephrologists managing these patients transitioning to adult care.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Renal Medicine

Background:

  • Pediatric end-stage renal disease (ESRD) etiology differs from adults.
  • Congenital anomalies of the kidney and urinary tract (CAKUT) are the primary cause, affecting 30% of pediatric CKD patients.
  • CAKUT often necessitates collaborative care between pediatric nephrologists and urologists.

Purpose of the Study:

  • To review the diagnosis and management of CAKUT in pediatric patients.
  • To highlight the importance of understanding CAKUT for adult nephrologists caring for transitioning patients.
  • To discuss strategies for managing bladder dysfunction associated with CAKUT.

Main Methods:

  • Literature review focusing on CAKUT diagnosis, interventions, and bladder dysfunction management.
  • Analysis of common CAKUT conditions encountered in pediatric nephrology and urology.
  • Discussion of management decisions, including surgical interventions.

Main Results:

  • Common CAKUT include antenatal hydronephrosis, obstructive uropathies (e.g., posterior urethral valves), and vesicoureteral reflux.
  • CAKUT management requires coordinated care addressing voiding issues and potential surgical needs.
  • Bladder dysfunction is a frequent complication requiring specific management strategies.

Conclusions:

  • Adult nephrologists require enhanced understanding of pediatric CAKUT for effective patient transition and care.
  • Familiarity with CAKUT diagnosis, natural history, and prognosis improves outcomes for pediatric patients entering adult healthcare systems.
  • Integrated management approaches, including surgical considerations, are vital for addressing CAKUT-related complications.

Keywords:
Bladder abnormalitiesChronic kidney diseaseCongenital kidney diseaseHydronephrosisKidney abnormalities

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