Principles of management of chronic kidney disease

Childhood onset chronic kidney disease can be indolent with slow gradual changes in symptoms and complications or fulminant, leading to the need for dialysis and transplantation within a short time frame. Improved identification of chronic kidney problems allows for early intervention, which can slow progression. Medical interventions for end-stage renal disease have improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, chronic kidney disease causes both direct and indirect insults to a variety of organ systems and has a profound psychosocial effect on the child and family.This review article provides a practical overview of chronic kidney disease including definition, classification based on estimated glomerular filtration rate and principles of management including prevention/slowing of progression and management of complications. Various options for renal replacement therapy are explored and the need for a multidisciplinary team approach to help meet the child’s educational, psychosocial and emotional health is discussed.