What causes chronic kidney disease (CKD) in children?

Updated: Jul 21, 2020
  • Author: Sanjeev Gulati, MD, MBBS, DNB(Peds), DM, DNB(Neph), FIPN(Australia), FICN, FRCPC(Canada); Chief Editor: Craig B Langman, MD  more...
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Answer

The chief causes of chronic kidney disease (CKD) in children include the following:

  • Obstructive uropathy

  • Hypoplastic or dysplastic kidneys

  • Reflux nephropathy

  • Focal segmental glomerulosclerosis as a variant of childhood nephritic syndrome

  • Polycystic kidney disease, autosomal-recessive and autosomal-dominant varieties

The distribution of causes varies with age. Whereas congenital anomalies of the kidney and urinary tract predominate in younger patients, glomerulonephritis is the leading cause in children older than 12 years of age. 

Despite the diverse etiologies, once chronic kidney disease develops, the subsequent response of the failing kidney is similar. The kidney initially adapts to damage by increasing the filtration rate in the remaining normal nephrons, a process called adaptive hyperfiltration. As a result, patients with mild chronic kidney disease often have a normal or near-normal serum creatinine concentration. Additional homeostatic mechanisms (most frequently occurring within the renal tubules) permit the serum concentrations of sodium, potassium, calcium, and phosphorous and total body water to also remain within the reference range, particularly among those with mild to moderate stages of chronic kidney disease.

Adaptive hyperfiltration, although initially beneficial, appears to result in long-term damage to the glomeruli of the remaining nephrons, which is manifested by pathologic proteinuria and progressive kidney insufficiency. This irreversibility appears to be responsible for the development of end-stage kidney failure among persons in whom the original illness is either inactive or cured.

Although the underlying problem that initiated chronic kidney disease often cannot be treated primarily, extensive studies in experimental animals and preliminary studies in humans suggest that progression in chronic renal disease may be largely due to secondary factors that are unrelated to the activity of the initial disease. These include anemia, osteodystrophy, systemic and intraglomerular hypertension, glomerular hypertrophy, proteinuria, metabolic acidosis, hyperlipidemia, tubulointerstitial disease, systemic inflammation, and altered prostanoid metabolism. This common sequence of events in diverse types of chronic kidney disease is the basis for the common management plan for children with chronic kidney disease, irrespective of the etiology.

A prospective multicenter cohort study by Greenberg et al that assessed long-term kidney outcomes after pediatric cardiac surgery (between one and 18 months of age) reported that at follow-up after cardiopulmonary bypass, 17% of the 131 children in the study (22 children) had hypertension and 18% (21 children) had chronic kidney disease. [5]  


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