Chronic Kidney Disease in Children: A Review

Mohd Ashraf, Muzafar Jan, Khurshid Ahmed Wani, Parvez Ahmed, Javid Ahmed, Sheikh Nisar Ahmed

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-9

Chronic kidney disease (CKD) in children is a life-consuming ailment with a variable but progressive course. CKD, in particular, the end stage kidney disease (ESKD) affects multiple body systems complexed with secondary complications that significantly and adversely affect the growth, development and quality of life. Although uncommon in children, CKD poses unique challenges to the health care delivery system to manage the primary renal disorders and extrarenal manifestations of CKD along with a heavy socioeconomic burden. Despite the availability of better management tools, there is a rise in incidence and prevalence of pediatric CKD for which wide range short- and long-term planning is inevitable that will lure the medicos to acquire the advanced nephrological training and skills, besides providing quality infrastructure and sustained socio-economic support. Our review is aimed to provide recent advances regarding the evaluation and management of pediatric CKD and its complications.


Cardiovascular disease (CVD) was recognized as a major cause of mortality and morbidity in adults with chronic kidney disease (CKD). Recent data indicate that cardiac complications are already present in children with advanced CKD. The main risk factors associated with cardiovascular mortality in adults include Coronary artery disease, left ventricular hypertrophy. Little is known regarding the specific risk factors for developing CVD morbidity and mortality in children. Based on recent reports, arrhythmia and cardiac arrest followed by cardiomyopathy and congestive heart failure were the leading causes of cardiac death in this pediatric population. This review summarizes the current literature on causes and pathophysiologic mechanisms of arrhythmias in the pediatric population with CKD, as the most common and life-threatening cardiac events. Herein, we focused our discussion on prompt diagnosis and management of common arrhythmias in children with CKD.


Principles of Cystinosis Transition in Children

Fatemeh Saffari, Banafshe Arad

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-6

Children with chronic illness need special care during the transition to adolescence and adulthood. Cystinosis is a chronic childhood disease characterized by chronic renal failure and multi-organ involvement. With advances in treatment and kidney transplantation methods, the life expectancy of these patients has been prolonged.  Renal transplantation is performed for most of the patients in childhood. These patients are at risk of non-adherence due to multiple drug usage and their chronic disease. As a child enters adulthood, parental care decreases and the patient should learn self-management. So the likelihood of non-compliance and loss of kidney transplant is high in transition time. This article gives a brief overview on transition of cystinosis patients from childhood to adolescence and adulthood

Original Research Papers

Comparative Evaluation of Carotid Intima-Media Thickness (CIMT) in Children with Early-Stage Chronic Kidney Disease and Healthy Individuals

Karim Sharifi, Rama Nagshizadian, Alireza Eskandarifar, Mohammad Gaderi, Abbas Alizadeh

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-4

Background and Aim: The prevalence of Chronic Kidney Disease (CKD) in children is 18 per million. The first stage of atherosclerosis in children at risk begins with vascular endothelial dysfunction and thickening of the intima-media of the arteries. The aim of this study was to evaluate the thickness of the carotid artery intima-media in children with early-stage chronic kidney disease.

Methods: The cases were selected from patients with chronic renal failure presenting to the pediatric nephrology clinic whose CKD was confirmed by ultrasound, kidney scan or laboratory tests. Ultrasound of all patients was performed by a sonographer and an ultrasound machine. The control group was also selected from subjects who presented to a kidney clinic for routine examination and testing without a history of any diseases and did not have kidney or cardiovascular disease. Chi-square and t tests, one-way analysis of variance, and Pearson’s correlation coefficient were applied to compare and describe the results.Results: One-way analysis of variance showed no significant difference in the mean carotid intima-media thickness (CIMT) between patients with early-stage CKD and control subjects. Moreover, according to the results of the Pearson’s correlation coefficient, there was no significant relationship between CIMT and laboratory variables in the patient group.

Conclusion: No significant relationship was observed in the carotid artery intima-media thickness between patients with early-stage CKD and control group. Thus, CIMT is not a reliable method in selection of high risk patients in early stages CKD but it can be very useful in high stages CKD.

Designing and Assessing the effectiveness of education through mobile application "Child Care" on knowledge, performance and satisfaction of parents of children with renal disease

Faezeh Javadi larijani, Mitra Zolfaghari, Aeen Mohammadi, Amir Adel Javadi larijani

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-4

Introduction: One of the most important diseases among children is urinary tract infection which can lead to permanent damage to the renal parenchyma with the possibility of delayed complications such as hypertension or chronic renal failure. The aim of designing and evaluating the effectiveness of education by the "Child Care of Kidneys" tool on the level of knowledge, practice and satisfaction of parents of children with kidney disease.
Methods: In this quasi-experimental study, 70 parents referred to the Pediatric Nephrology Clinic in the Pediatric Nephrology Clinic were enrolled in the study in 1398 (35 received traditional training and 35 received face-to-face training by installing an application on the Android mobile phone, after 6 weeks the questionnaire was completed and the data were analyzed. The software used was version 23 of SPSS software. Significance level was considered 0.05.
Results: The mean score of knowledge in both groups was equal to 6 ±1 (moderate). There was no statistically significant difference between the knowledge scores of the two groups (0.68). The performance score of the traditional training group was 12±2 (average) and the second group who were trained with the application was 13 ± 2 (moderate). There was a statistically significant difference between the performance scores of the two groups (0.02). The satisfaction score of the application was relatively good.
Discussion and Conclusion: Parent education through the installation of applications on mobile phones has a very good effect on the performance and satisfaction of parents of children with kidney disease.

Evaluating the Importance of Factors Effecting the Consumer Behavior in new Dialysis Machine in Iran-Tehran

Seyed Mahameddin Tabatabaei , Vahid Reza Mirabi , Mohammad-Ali Afshar Kazemi, Foroozan Fares

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-6

Background and Aim: The health care industry is very critical base on its relation to human life. The amount of research and changes in the diagnostic techniques and procedures, therapeutic techniques, drugs and equipment are very vast and fast. In order to prevent the waste of resources, it is required to understand the needs and wants of the market. Therefore, it is very crucial to understand the patient’s opinion.

Methods: By reviewing the literature of consumer behavior theories, a number of factors are classified into seven categories. Based on this classification a questionnaire was developed. The main respondents were parents of a child who is suffering from renal failure. Then, two statistical tests were held using t-test in order to identify the importance and prioritizing of each factor also correlation coefficient to understand the availability and strength of relationship among factors.

Results: The results base on the statical tests indicates that the three groups of factors do not affect consumer behavior. The rest of the factors have an influence on consumer behavior regarding a new product. 

Base on the result hospitals and clinics that have hemodialysis sections with the specialty of delivering service to children should recognize the product accuracy, the lowest possible price, with vast of informative activity to parents and the children and doctors. 

Conclusion: These approaches will smooth the way for hospitals and clinics to launch new services to renal failure patients.

Case Reports

Teratoid wilms tumor: Case Report and Review of Literature

Kiran Agarwal, Amrita Anand; Smita Singh; Neha Suman

Journal of Pediatric Nephrology, Vol. 8 No. 4 (2020), 21 Shahrivar 2020, Page 1-9

Teratoid Wilm’s tumor is a rare variant of Wilm’s tumor, which composed of well-differentiated epithelial cells or mesenchymal heterologous elements constituting more than 50% of the conventional wilm’s tumors in pediatric group. We hereby report an additional case in a 6-year-old female along with review of literature.


Photo quiz