Chronic Kidney Disease

Chronic Kidney Disease

Paul R. Brakeman


The prevalence of chronic kidney disease varies significantly between studies and is in the range of 25 to 50 per million children.


The most common causes of CKD in North America are listed in Table 23-2. The most common cause of CKD in children in North America are congenital anomalies of the kidney and urologic tract known as CAKUT and represent nearly half of all cases of CKD in children. In younger patients, congenital anomalies are more common while in adolescent patients the various forms of glomerulonephritis are the most common cause of CKD.


As CKD progresses, individual nephrons are lost and the total glomerular filtration rate (GFR) decreases. To compensate, the remaining nephrons increase the fraction of filtrate that is excreted as urine. Thus, substances that depend on glomerular filtration for excretion such as urea nitrogen accumulate while substances such as salt, potassium, and water may remain in homeostasis until the final stages of CKD. This is specifically true in the case of CKD resulting from congenital obstructive uropathy or hypoplastic/dysplastic kidneys in which a patient may reach end stage renal disease with a normal urine output and near normal excretion of sodium and potassium.


Many of the same biochemical abnormalities occur in CKD and ARF; however, in CKD persistence of these abnormalities results in organ system pathology such as renal osteodystrophy.