Pediatric emergency medicine trisk 2910 2910
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Children may present to the ED with previously undiagnosed
CKD.
Life-threatening electrolyte and acid–base disturbances may be
present on presentation requiring emergent intervention.
Management must focus on restoring homeostasis while treating
any potential underlying causes.
Patients may require emergent RRT.
Current Evidence
The definition of CKD is based upon persistent structural or functional
abnormalities, which may be associated with reduced or normal GFR. It
may be due to congenital or acquired pathologies. The natural history of
CKD is variable and depends upon the severity of the underlying kidney
damage. A significant insult or progressive loss of functioning nephron
mass may lead to ESRD. In 2002, the National Kidney Foundation Kidney
Disease Outcomes Quality Initiative published diagnostic criteria and a
classification scheme to define the stages of CKD in patients older than 2
years ( Table 100.15 ).
Goals of Treatment
Emphasis is placed on early detection and intervention as measures to
inhibit the progression of renal dysfunction include treating hypertension
and reducing significant proteinuria. For children who progress to ESRD,
therapies include chronic hemodialysis, peritoneal dialysis, and renal
transplantation. Renal transplantation is recognized as the preferred
treatment for children with ESRD, as restoration of normal renal
physiologic function can greatly improve the child’s quality of life.
Clinical Considerations
Clinical recognition. The clinical presentation of CKD will depend upon
the severity of the renal dysfunction and the underlying cause. Children
with mild CKD (stage 1 and 2) and no other comorbidities may be
asymptomatic. Children with more severe CKD are at increased likelihood
for associated signs and symptoms such as fatigue, anorexia, and poor
growth. Furthermore, these children may present for emergent care with a
