Chronic Kidney Disease - Pediatric by

Population of Interest

dcfutch — 2025-10-11 12:42:16 UTC

Chronic Kidney Disease (CKD) affects almost 10% of the worldwide population and data estimates 15-95 cases per million on that same scale. While studies show Chronic Kidney Disease is more likely in older populations, data is scarce in the pediatric population and the true epidemiology and global health burden in children needs to be clarified. (Raina et al., 2025) Pediatric Chronic Kidney Disease has lasting effects well into adulthood, as overall the disease is an increasing global public health concern. (Gerber & Kamath, 2025)

Children with CKD are at an increased risk of chronic cardiovascular disease, obstructive respiratory disease, and mental illness in adulthood. Thus, timely diagnosis, intervention, and monitoring are of utmost importance in the pediatric population, which requires an understanding of the etiologies behind CKD in children. (Raina et al., 2025)

Factors Leading to the Clinical Concern

dcfutch — 2025-10-11 13:15:04 UTC

Obesity: International Pediatric Peritoneal Dialysis Network found that 19.7% of children worldwide were overweight or obese at the start of chronic peritoneal dialysis (PD) (Gerber and Kamath, 2025).
Low birth weight and prematurity, as the average human kidney has 1 million nephrons, and typically formed during the third trimester of pregnancy. Low birth weight and prematurity have a significant impact on the development.
Urologic problems impact CKD progression
Rapid growth periods, including puberty
Community and family-level factors
- low level literacy and level of education
  - less likely to graduate high school, experience grade retention, report academic challenges, and miss significant amounts of school due to illness (Richardson et al., 2024)
Societal factors
- socioeconomic disparities, ethic discrimination, environmental toxins

Epidemiologic Evidence of the Problem

dcfutch — 2025-10-11 13:19:19 UTC

Chronic Kidney Disease is the third fastest-growing cause of death worldwide, and the only non-communicable disease to exhibit a continued rise in age-adjusted mortality; and by 2040, is projected to be the 5th highest cause of years of life lost in the world. (Raina et al., 2025) Since Pediatric CKD is oftentimes initially asymptomatic, capturing reliable data is generally difficult at best. Based on this data, or lack thereof, kidney registries and epidemiological studies, the prevalence of pediatric CKD is approximately 30-100 cases per million age-related population, suggesting about 1 in every 10,000 children has CKD (Raina et al., 2025) This data may be questionable, as many reported cases are from resource-limited countries where patients are confined to tertiary are center or information not being reported all together.

Pathophysiology Review

dcfutch — 2025-10-11 13:36:32 UTC

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), accounting for 50-65% of children with CKD

Other common etiologies of pediatric CKD are obstructive uropathy, steroid resistant nephrotic syndrome (e.g., focal segmental glomerulosclerosis) and chronic glomerulonephritis, which account for 20% of CKD in children. Additionally, Alport syndrome, cystinosis, and post-acute kidney injury account for 15%. Monogenic causes are found in 10-60% of children with CKD due to CAKUT or glomerulonephritis. (Gerber and Kamath, 2025)

Population Interventions

dcfutch — 2025-10-11 14:35:18 UTC

Promotion of healthy lifestyles: including physical activity; healthy eating
Identifying risk factors
- obesity
- hypertension
Early screening to identify CKD to monitor and manage more effectively
Educational and psychosocial support to assist children in coping with their illness
Increase awareness, publicly and professionally, to advise all of the seriousness of the disease, it's risk factors and importance of early detection and treatment options.

Pharmacologic Treatments

dcfutch — 2025-10-11 14:37:28 UTC

Recombinant human GH (rhGH) improves growth in children with CKD with impaired growth and has relatively few side effects
- Although no randomized controlled trials have evaluated the association between rhGH administration in childhood CKD and final adult height, a case-control study concluded that children treated with GH had sustained catch-up growth. (Gerber and Kamath, 2025)
Thyroid dysfunction
- treatment of overt hypothyroidism improves growth in children with CKD
Anemia
- Erythropoiesis-stimulating agents (ESAs) used to treat anemia caused by CKD
- Iron supplements: often combined with ESA for sufficient iron for red blood cell production
Hypertension
- ACE inhibitors andARBs: used to help lower blood pressure and slow the progression of CKD
- Diuretics: helps patients with fluid retention, as well as an add-on to ACE inhibitors/ARBs

References

dcfutch — 2025-10-11 14:41:03 UTC

Gerber, A., & Kamath, N. (2025). Not Just Small Adults: Considerations for Pediatric Chronic Kidney Disease. Indian Journal of Nephrology, 35(2), 1–10. https://doi.org/10.25259/IJN_77_2024

Raina, M., Shah, R., Hu, J., Pember, B., Cahill, T., Bunchman, T., Yap, H. K., & McCulloch, M. (2025). The global health burden of pediatric chronic kidney disease: An analysis of the Global Burden of Disease database from 1990 to 2021. PLoS ONE, 20(5), 1–20. https://doi.org/10.1371/journal.pone.0323257

Richardson, K., Ward, R. C., & Harshman, L. A. (2024). Education and employment outcomes in pediatric chronic kidney disease. Pediatric Nephrology, 39(12), 3411–3423. https://doi.org/10.1007/s00467-024-06431-4