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Chronic renal failure in children.

J G Mongeau, P Robitaille, M M Grall

    Canadian Medical Association Journal
    |April 22, 1978
    PubMed
    Summary

    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.

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    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.

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