end stage renal disease in children. end stage kidney disease occurs when the kidneys are no longer...
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End Stage Renal Disease End Stage Renal Disease in Childrenin Children
End Stage Renal Disease End Stage Renal Disease in Childrenin Children
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End stage kidney disease occurs when the kidneys are no longer able to function at a level that is necessary for day to day life it usually occurs as chronic renal failure worsens to the point where kidney function
is less than 10% of normal
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At this point the kidney function is so low that without dialysis or kidney transplantation, complication are multiple and severe, and death will occur from accumulation and waste products in the body
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IncidenceIncidenceIncidenceIncidence
Incidence rates for children (0 to 19 years old),
adjusted for age, race, and sex, average 10 to
12 per million adjusted population, a rate that
has not changed substantially in more than a
decade.
Incidence rates for children (0 to 19 years old),
adjusted for age, race, and sex, average 10 to
12 per million adjusted population, a rate that
has not changed substantially in more than a
decade.
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Primary Disease Leading To CRFPrimary Disease Leading To CRFPrimary Disease Leading To CRFPrimary Disease Leading To CRFCongenital/Other hereditary diseasesCongenital/Other hereditary diseases
GlomerulonephritisGlomerulonephritis
Cystic kidney diseaseCystic kidney disease
Pyelonephritis & reflux nephropathyPyelonephritis & reflux nephropathy
Renal vascular diseaseRenal vascular disease
Sickle cell diseaseSickle cell disease
Collagen vascularCollagen vascular
Interstitial nephritisInterstitial nephritis
Metabolic diseasesMetabolic diseases
MalignanciesMalignancies
HUS/TTPHUS/TTP
OtherOther
20.2
41.5
5.0
5.8
2.9
0.5
0.5
3.7
0.1
8.3
5.9
2.2
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Delaying or halting progression Delaying or halting progression of CRFof CRF
Delaying or halting progression Delaying or halting progression of CRFof CRF
Treatment of the underlying condition if possible
Aggressive blood pressure control to target value
Use of ACE inhibitors as tolerated, with close monitoring for renal deterioration and for hyperkalemia (avoid in advanced renal failure, bilateral renal artery stenosis [RAS], RAS in a solitary kidney)
Aggressive glycemic control in patients with diabetes
Protein restriction - Controversial
Treatment of hyperlipidemia
Avoidance of nephrotoxins - IV radiocontrast, nonsteroidal anti-inflammatory agents, aminoglycosides
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Signs and symptoms of chronic Signs and symptoms of chronic renal failurerenal failure
- growth retardation
- anemia
- metabolic acidosis
- hypertension
- anorexia
- lethargy
- electrolyte disorders
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Treatment of growth failureTreatment of growth failure
- vitamin alpha-D3
- calcium
- sodium bicarbonate
-growth hormone
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Signs and symptoms of chronic Signs and symptoms of chronic renal failurerenal failure
- growth retardation
- anemia
- metabolic acidosis
- hypertension
- anorexia
- lethargy
- electrolyte disorders
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Anemia treatmentAnemia treatment
- Iron
- Erythropoietin
- Folic acid
- Vitamin B12
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Treating pathologic Treating pathologic manifestations of ESRDmanifestations of ESRD
Treating pathologic Treating pathologic manifestations of ESRDmanifestations of ESRD
Erythropoietin (IV or SC)Iron (PO or IV)Dietary phosphate binders and dietary phosphate restriction Calcium supplementsCalcitriol or vitamin D analogs Oral alkali supplementation Growth hormone (SC, daily)Vitamins ( group B, folic acid)Aggressive blood pressure control (often more than one drug)Kayexalate
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Treatment uremic manifestations with chronic renal replacement therapy (hemodialysis, peritoneal dialysis, or renal transplantation).
Indications include severe metabolic acidosis, hyperkalemia, pericarditis, encephalopathy, intractable volume overload, failure to thrive and malnutrition, peripheral neuropathy, intractable gastrointestinal symptoms, and GFR less than 10 cc/min
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Replacement Therapy
Dialysis Peritoneal Hemodialysis
Transplant Living Donor
Related Unrelated
Cadaveric Donor
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HemodialysisHemodialysis
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Peritoneal dialysisPeritoneal dialysis
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Advantages of PDAdvantages of PD
ABILITY TO PERFORM DIALYSIS TREATMENT AT HOME
TECHNICALLY EASIER THAN H.D. ESPECIALLY IN INFANTS
ABILITY TO LIVE A GREATER DISTANCE FROM MEDICAL CENTER
FREEDOM TO ATTEND SCHOOL AND AFTER
LESS RESTRICTIVE DIET
LESS EXPENSIVE THAN H.D.
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Disadvantages of PDDisadvantages of PD
CATHETER MALFUNCTION
CATHETER RELATED INFECTIONS
NEGATIVE BODY IMAGE
IMPAIRED APPETITE
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