Early Detection in Minority Groups Could Help With Pediatric CKD

The authors of an editorial published in Journal of the National Medical Association found that pediatric chronic kidney disease (CKD) could be best treated if found early and if minority groups were screened due to their increased risk. They also said that a collaboration between health care systems and pediatric nephrologists could go a long way in achieving these goals.

Children can develop CKD in a variety of ways. Congenital anomalies of the kidney and urinary tract, cystic and hereditary disorders, and glomerulonephritis are some causes of CKD. Heart disease, past acute kidney injury, and family history of CKD are also factors in the pediatric development of CKD.

Congenital causes are the mostly commonly reported etiology from developed countries where CKD is diagnosed in the early stages, according to the authors. However, infectious or acquired causes of CKD are predominant in developing countries. CKD is a common complication of pediatric malignancies and stem cell transplantation because of nephrotoxic chemotherapeutic agents, radiation, surgical interventions, and exposure to other nephrotoxic medications.

Children with sickle cell disease (SCD) can have albuminuria due to glomerular hyperfiltration and have been reported to have a more rapid decline in kidney function. Sickle cell nephropathy can often lead to CKD in adults with SCD, with up to 12% of people with CKD and SCD progressing to end-stage renal disease (ESRD).

Estimates of the causes of CKD in children in America are derived from the Chronic Kidney Disease in Children study and the registry of the North American Pediatric Renal Trials and Collaborative Studies organization. Although CKD stages 2 to 5 are poorly characterized, population-based studies suggest that prevalence of pediatric CKD may be as high as 1%.

The prevalence of decreased glomerular filtration rate (GFR) in adolescents in the United States is approximately 0.51%, according to the United States Renal Data System (USRDS). The USRDS estimates that the prevalence of CKD in children is 2.7 per 1000 children with health care coverage. Black/African American, Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Pacific Islanders all have an increased risk of developing CKD.

Black/African American individuals are nearly 4 times as likely to have kidney failure vs White people and are more likely to progress to ESRD. There are biological and nonbiological factors involved in this disparity. Premature birth is associated with increased risk of CKD because of low nephron endowment and birth weight. African American women have a higher rate of premature births.

Gestational determinants, low income, and maternal education can have an effect on socioeconomic status, which in turn can have an impact on development and progression of CKD in children. Low-income neighborhoods are disproportionally exposed to environmental risk factors and have predominantly minority residents.

Children with CKD will have more health problems than those without, the authors highlighted. The risk of cardiovascular mortality is increased in children with CKD with abnormal glucose metabolism, obesity, dyslipidemia, and hypertension. Growth failure or impaired growth can also be found in children with CKD due to malnutrition, fluid and electrolyte disturbances, metabolic acidosis, anemia, renal osteodystrophy, and inflammation.

CKD is a disease that can have a big impact on the lives of children who receive the diagnosis. The authors suggest steps to diagnose and manage the care of CKD in children.

Children who are a high risk of CKD should be identified and screened for CKD using serum creatinine and cyastin measurements to determine estimated GFR and urine albumin to creatinine or protein to creatinine ratios should also be recorded.

Lifestyle modifications, like regular exercise and healthy eating, should be included in a CKD treatment plan for children who are found to have CKD. Blood pressure control and proteinuria management will also help the prevention of progression of CKD. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers should also be used as treatment for pediatric CKD. Nephrologist treatment and early detection by primary care providers is vital for stopping the progression of CKD.

“A strong collaboration between the primary health care system and a nephrologist will create early awareness to address the crucial public health issue of CKD and also trigger the opportunity for effective management of the disease,” the researchers concluded.

Reference

Beng-Ongey H, Robinson JS, Moxey-Mims M. Chronic kidney disease emerging trends in children and what to do about it. J Natl Med Assoc. Published online May 31, 2022. doi:10.1016/j.jnma.2022.05.002