What’s New in Chronic Kidney Disease: a topical collection
Chronic kidney disease (CKD) in childhood brings with it multiple complications that cause considerable morbidity and increased mortality too. The true incidence of CKD in childhood is not known. Figures quoted range from 2 to 16 per million child population per year depending on area, and reflecting local resources. These figures are likely to be underestimates throughout the world, because many children go undiagnosed and may not present even until adulthood. Furthermore, we are now recognising new groups of children at increased risk of CKD who therefore need surveillance: such as premature infants; after acute kidney injury; and the increasing numbers affected by obesity and metabolic syndrome. Although the etiologies of CKD are multiple, progressive destruction of renal tissue occurs through a common pathway regardless of the cause. Intrarenal pathology leads to abnormal hemodynamics, chronic hypoxia, inflammation, cellular dysfunction, and activation of fibrogenic biochemical pathways. The end result is the replacement of normal structures with extracellular matrix, culminating in fibrosis. So can we prevent this unremitting process? Can we find new biomarkers to improve early detection and staging of CKD? How can we reliably predict progression? How can we slow progression? Can we better manage the symptoms and complications of CKD and reduce long term morbidity and mortality? This Topical Collection brings together the latest research and reviews in pediatric CKD with the aim of resourcing pediatric nephrologists to better treat and care for our patients.