End Stage Renal Disease in Children

End stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life it usually occurs as chronic renal failure worsens to the point where kidney function is less than 10% of normal

At this point the kidney function is so low that without dialysis or kidney transplantation, complication are multiple and severe, and death will occur from accumulation and waste products in the body

IncidenceIncidence Incidence rates for children (0 to 19 years old), adjusted for age, race, and sex, average 10 to 12 per million adjusted population, a rate that has not changed substantially in more than a decade. Incidence rates for children (0 to 19 years old), adjusted for age, race, and sex, average 10 to 12 per million adjusted population, a rate that has not changed substantially in more than a decade.

Primary Disease Leading To CRF Congenital/Other hereditary diseases Glomerulonephritis Cystic kidney disease Pyelonephritis & reflux nephropathy Renal vascular disease Sickle cell disease Collagen vascular Interstitial nephritis Metabolic diseases Malignancies HUS/TTP Other

Delaying or halting progression of CRF Treatment of the underlying condition if possible Aggressive blood pressure control to target value Use of ACE inhibitors as tolerated, with close monitoring for renal deterioration and for hyperkalemia (avoid in advanced renal failure, bilateral renal artery stenosis [RAS], RAS in a solitary kidney) Aggressive glycemic control in patients with diabetes Protein restriction - Controversial Treatment of hyperlipidemia Avoidance of nephrotoxins - IV radiocontrast, nonsteroidal anti-inflammatory agents, aminoglycosides

Signs and symptoms of chronic renal failure - growth retardation - anemia - metabolic acidosis - hypertension - anorexia - lethargy - electrolyte disorders

Treatment of growth failure - vitamin alpha-D3 - calcium - sodium bicarbonate - growth hormone

Signs and symptoms of chronic renal failure - growth retardation - anemia - metabolic acidosis - hypertension - anorexia - lethargy - electrolyte disorders

Anemia treatment - Iron - Erythropoietin - Folic acid - Vitamin B12

Treating pathologic manifestations of ESRD Erythropoietin (IV or SC) Iron (PO or IV) Dietary phosphate binders and dietary phosphate restriction Calcium supplements Calcitriol or vitamin D analogs Oral alkali supplementation Growth hormone (SC, daily) Vitamins ( group B, folic acid) Aggressive blood pressure control (often more than one drug) Kayexalate

Treatment uremic manifestations with chronic renal replacement therapy (hemodialysis, peritoneal dialysis, or renal transplantation). Indications include severe metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable volume overload, failure to thrive and malnutrition, peripheral neuropathy, intractable gastrointestinal symptoms, and GFR less than 10 cc/min

Replacement Therapy Dialysis  Peritoneal  Hemodialysis Transplant  Living Donor  Related  Unrelated  Cadaveric Donor

Hemodialysis

Peritoneal dialysis

Advantages of PD ABILITY TO PERFORM DIALYSIS TREATMENT AT HOME TECHNICALLY EASIER THAN H.D. ESPECIALLY IN INFANTS ABILITY TO LIVE A GREATER DISTANCE FROM MEDICAL CENTER FREEDOM TO ATTEND SCHOOL AND AFTER LESS RESTRICTIVE DIET LESS EXPENSIVE THAN H.D.

Disadvantages of PD CATHETER MALFUNCTION CATHETER RELATED INFECTIONS NEGATIVE BODY IMAGE IMPAIRED APPETITE