Сhronic kidney disease in children: principles of ambulatory management

Abstract

Introduction. The term «chronic kidney disease» (CKD) is used to define the outcomes of various forms of chronic progressive kidney disease, characterized by kidney damage, or a decrease in their function for three months or more, regardless of the nosological diagnosis. The aim of the work was to determine the frequency, structure, and clinical and paraclinical features of CKD in children to substantiate the principles of its management in primary health care. Results. In CKD patients, tubulointerstitial renal lesions were established to prevail (80%). Associated with congenital malformations of the urinary system, reflux uropathy, and urolithiasis in 98% of cases tubulointerstitial renal lesions are complicated by renal infection. In 8.9% of children, CKD was formed as an outcome of glomerulopathies; in 6.7% of children - with congenital and hereditary nephropathies; in 4.4% of children an outcome of a hemolytic uremic syndrome. The observed children dominated by I-II (74.3%), less often III and IV (25.7%) stages of CKD. The revealed clinical and paraclinical features of CKD in children are presented. The modern principles of early diagnosis of CKD in children and the identification of risk factors for the progression of nephropathy have been substantiated. For the diagnosis of CKD in childhood there has been created a. n algorithm, including at the outpatient stage. Authors suggested a set of measures for the prevention of nephropathy. Conclusion. For early diagnosis of CKD in childhood there was developed an algorithm based on the analysis of a complex of clinical and paraclinical, structural and functional parameters of the kidneys in combination with the parameters of endothelial function and cytokine status.