Chronic renal failure in children

　　Chronic renal failure in children often occurs secondary to other diseases. Renal parenchymal lesions and renal function damage caused by various reasons can lead to the occurrence of this disease. Common causes include the following:

　　1. Infectious kidney disease, such as chronic pyelonephritis, renal tuberculosis, etc.

　　2. Chronic glomerulonephritis, such as IgA nephropathy, membranous proliferative glomerulonephritis, focal segmental sclerotic glomerulonephritis, and mesangial proliferative glomerulonephritis, etc.

　　3. Toxic nephropathy, such as heavy metal poisoning nephropathy, analgesic nephropathy, etc.

　　4. Vascular kidney disease, such as renal vascular hypertension, hypertension, and renal arteriosclerosis, etc.

　　5. Obstructive kidney disease, such as ureteral obstruction, reflux nephropathy, urinary tract stones, etc.

　　6. Systemic diseases, such as vasculitis kidney damage, multiple myeloma, lupus nephritis, etc.

　　7. Kidney damage caused by metabolic abnormalities, such as diabetic nephropathy, amyloidosis nephropathy, and gouty nephropathy, etc.

　　Children with chronic renal failure often have complications such as hypertension, anemia, heart failure, pericarditis, cardiomyopathy, electrolyte and acid-base imbalance, renal osteodystrophy, fractures, infection, and so on. In addition to the above systemic complications, chronic renal failure patients undergoing long-term dialysis may also have the following complications.

　　1. Aluminum poisoning: End-stage renal disease patients receiving conventional dialysis treatment are prone to aluminum poisoning.

　　2. Dialysis-related amyloidosis: Dialysis-related amyloidosis (DRA) is a bone and joint disease seen in long-term dialysis patients. Its clinical symptoms and incidence are closely related to the duration of dialysis.

　　Before the patient develops renal failure, other kidney diseases are often diagnosed. Although patients have anatomical abnormalities, their manifestations may be non-specific, such as headache, fatigue, anorexia, vomiting, thirst, polyuria, and growth retardation. The vast majority of renal failure patients have pale complexion, fatigue, and can have growth retardation and rickets.

　　In the prevention of pediatric chronic renal failure, attention should be paid to the active prevention and treatment of various primary diseases that can cause the disease, such as chronic nephritis and pyelonephritis. For those with renal damage, active prevention and treatment of infection, control of hypertension, and avoidance of nephrotoxic drugs are necessary. Daily attention should be paid to reasonable diet and rest.

　　Due to the non-specific clinical manifestations of pediatric chronic renal failure, diagnosis mainly relies on chemical tests. The main examination methods include the following several types:

　　1. Urine examination

　　In the late stage of renal function impairment, urinary protein is reduced. Urinalysis shows varying degrees of hematuria and cast urine. Large, broad waxy casts are of diagnostic value for chronic renal failure.

　　2. Blood routine examination

　　Hemoglobin levels decrease, generally below 80g/L, and in severe cases, below 50g/L. White blood cells are normal or decreased, and they can increase in cases of infection or severe acidosis. Platelets are normal or decreased. Erythrocyte sedimentation rate increases.

　　3. Blood biochemistry examination

　　The examination shows a total protein of 1.6 mmol/L in plasma, and the gap of blood potassium, sodium, chloride, and anions varies with the condition.

　　4. Renal function examination

　　Examinations show varying degrees of renal function impairment.

　　5. Other examinations

　　X-ray abdominal films, B-ultrasound, radionuclide renal scans, CT, and MRI scans are very helpful in determining the shape, size, and whether there is urinary tract obstruction, hydronephrosis, calculi, cysts, and tumors of the kidneys. In the late stage of chronic renal failure, the shrinkage of renal volume (excluding polycystic kidney disease and renal tumors) is a characteristic change.

　　In addition to identifying the cause and treating it directly, diet is also an important part of the treatment for pediatric chronic renal failure. It is necessary to ensure that the child receives sufficient nutrition to meet the needs of growth and development, while also reducing the burden on the kidneys to maintain renal function. The main measures of dietary treatment are as follows:

　　1. Sufficient energy and carbohydrates should be provided.Energy is provided by carbohydrates and moderate amounts of fat. It is more suitable to eat refined starch and monosaccharides, disaccharides, and other foodstuffs.

　　2. Limiting protein intakeRestricting protein intake mainly involves restricting plant proteins (with low biological value). High-quality animal proteins should be supplied in moderation. For moderate renal insufficiency, 1-2 grams of protein per kilogram of body weight per day (2-3 grams per day is appropriate for normal children). For severe renal insufficiency, 0.6-1 gram of protein per kilogram of body weight per day should be provided.

　　Chronic renal failure in children seriously affects the daily life of patients, so once diagnosed, treatment should be given immediately. Attention should be paid to the following aspects during treatment.

　　Firstly, the treatment of water and electrolytes

　　Mild dehydration can be corrected by oral rehydration. If there is fever, vomiting, or diarrhea, it is necessary to replenish water. In cases of severe dehydration, immediate fluid resuscitation is required. When there is excess water, the intake of water should be strictly controlled. In severe edema, furosemide can be injected intravenously for diuresis. When a large amount of sodium is lost, sodium should be supplemented through diet. However, when there is hypertension, edema, or congestive heart failure, sodium intake should be restricted.

　　Secondly, the treatment of symptoms in various systems

　　1. Renal osteopathyRegularly monitor blood calcium and phosphorus, and prevent hyperthyroidism and extrarenal calcification of the skeleton. Control hyperphosphatemia, use phosphorus-binding agents. Supplement calcium salts, commonly using dihydrotachysterol or calcitriol.

　　2. Controlling hypertensionThe basic treatment principle for hypertension in chronic renal failure is to delay the progression of renal failure. Commonly used drugs include hydrochlorothiazide (diuretic), chlorthalidone, hydralazine (hydralazine), and others.

　　3. Anemia and bleedingErythropoietin can treat chronic anemia in patients. For those with severe bleeding, a small amount of fresh blood or plasma may be given. Dialysis therapy can help reduce bleeding. Antifibrinolytic hemostatic agents may be used in severe bleeding cases.

　　4. Preventing tubular and interstitial damageAlkaline drugs have the effect of protecting the tubules and interstitium from damage. The commonly used alkaline drug is sodium bicarbonate.