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Chronic renal failure in children
Insights
Chronic renal failure in children is often irreversible by school age, with urinary tract malformations being a primary cause. Early detection of kidney disease in schoolchildren may not prevent chronic renal failure due to irreversible damage.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Public Health
Background:
- Chronic renal failure (CRF) in children presents a significant health challenge.
- Understanding the etiological factors and disease progression is crucial for effective management.
- Previous studies have highlighted various causes, but specific insights into early-life progression are needed.
Purpose of the Study:
- To investigate the incidence and causes of chronic renal failure in children.
- To analyze the factors influencing the progression of CRF in pediatric patients.
- To evaluate the potential impact of early screening programs on CRF prevention.
Main Methods:
- Retrospective analysis of 77 children diagnosed with CRF between 1970 and 1975 in Quebec.
- Categorization of CRF causes including urinary tract malformations, glomerulonephritis, congenital renal parenchymal malformations, and hereditary nephropathies.
- Evaluation of disease evolution based on initial severity, age at diagnosis, and specific conditions like vesicoureteral reflux and posterior urethral valves.
Main Results:
- An incidence of 2.5 per million population per year was observed.
- Urinary tract malformations were the leading cause (36%), followed by chronic glomerulonephritis (22%), congenital renal parenchymal malformations (21%), and hereditary nephropathy (13%).
- Disease progression in children with vesicoureteral reflux or posterior urethral valve correlated with initial disease severity, not age at diagnosis. Renal parenchymal damage appeared irreversible by school age.
Conclusions:
- Screening programs for schoolchildren may not prevent CRF due to irreversible renal damage at that age.
- The evolution of chronic glomerulonephritis is influenced by the nephrotic syndrome and histological findings.
- Congenital renal hypoplasia/dysplasia can manifest as hypertensive encephalopathy without prior renal symptoms; familial nephropathies, like cystinosis, may benefit from early renal transplantation.
Abstract:
Seventy-seven children with chronic renal failure were examined at one hospital in the province of Quebec between 1970 and 1975; this represents an incidence of 2.5 per million population per year. The entities responsible for chronic renal failure were urinary tract malformation (in 36%), chronic glomerulonephritis (in 22%), congenital renal parenchymal malformation (in 21%) and hereditary nephropathy (in 13%). The evolution of chronic renal failure in children with either vesicoureteral reflux or a posterior urethral valve seemed to be related more to the initial severity of the disease than to the age at the time of diagnosis. Hence any screening program designed to detect kidney disease in schoolchildren would not prevent chronic renal failure, since at that age renal parenchymal damage seems to be irreversible. The manner in which chronic glomerulonephritis evolved depended on whether the nephrotic syndrome was present and on the type of histologic lesion. Children with congenital renal hypoplasia or dysplasia often presented with seizures due to hypertensive encephalopathy without obvious symptoms or signs of pre-existing renal disease. Among patients with familial nephropathy many of those with cystinosis underwent successful renal transplantation early in life.