THE CAUSES AND THE COURSE OF CHRONIC KIDNEY DISEASE IN CHILDREN OF PRESCHOOL AGE

Abstract

Background: Data on etiology and clinical course of CKD stage 3 to 5 in children of preschool age could help obstetricians, pediatricians, and nephrologists with proper diagnostics and management of this condition and prediction of outcomes. Aim: To study causes and clinical features of CKD stage 3 to 5 in preschool children. Materials and methods: The causes and clinical features of CKD stage 3 to 5 were investigated in 55 preschool children aged from 7 months to 8 years. Twenty four had CKD stage 3 to 4 and 31 children with endstage CKD were on peritoneal dialysis. Results:96% of CKD stage 3 to 5 in preschool children were due to congenital/genetic kidney abnormalities. Predictors of renal replacement therapy beginning in the first 5 years of life were as follows: antenatal detection of congenital abnormalities of the kidney and urinary tract, oligohydroamnion, high neonatal BUN levels. Anemia, hyperparathyroidism, arterial hypertension were more prevalent in children on the dialysis stage of CKD, and myocardial hypertrophy and/or of the left ventricle dilatation were found in 26% of them. Forty two percent of children had growth retardation, and 40% had delayed speech development. Conclusion: The course CKD in preschool children is characterized by a combination of typical metabolic disorders with the growth retardation (often dramatic) and delayed mental development that significantly limits the possibilities of the social adaptation of these children and social activities of their parents. Participation of neuropsychiatrists, clinical psychologists, and teachers, rather than pediatricians and nephrologists only, is desirable in management of preschool children with CKD stage 3 to 5.

Keywords

• children
• chronic kidney disease
• congenital renal and urinary tract abnormalities