Urologic Considerations in Pediatric Chronic Kidney Disease

Common causes of pediatric ESRD are distinct from those seen in the adult population. In the pediatric population, the most common are congenital anomalies of the kidney and urinary tract (CAKUT), affecting approximately 30% of children with CKD. These structural anomalies often require coordinated care with the pediatric urology team to address voiding issues, bladder involvement, and the potential need for surgical intervention. For pediatric nephrologists and urologists, common CA-KUT that are encountered include antenatal hydronephrosis, obstructive uropathies (eg, posterior urethral valves), and vesi-coureteral reflux. As more pediatric patients with CAKUT, CKD, and ESRD transition to adult care, it is important for receiving adult nephrologists to understand the clinical presentation, natural history, and prognosis for these diagnoses. This review outlines the diagnosis and potential interventions for these conditions, including strategies to address bladder dysfunction that is often seen in children with CAKUT. A discussion of these management decisions (including surgical inter-vention) for CAKUT, which are quite common to pediatric nephrology and urology practices, may provide unique learning op-portunities for adult nephrologists who lack familiarity with these pediatric conditions.(c) 2022 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

The causes of pediatric ESRD are different from those in adults, with congenital anomalies of the kidney and urinary tract being the most common. These structural abnormalities require coordinated care with pediatric urology teams. Pediatric nephrologists and urologists often encounter cases such as antenatal hydronephrosis, obstructive uropathies, and vesicoureteral reflux.