The outcomes of children receiving CRRT is proportional to the underlying
condition of the child. Patients with fluid overload at initiation of therapy, multi-
organ failure, hemodynamic instability and younger age are factors influencing
the outcomes of kidney injury and not necessarily CRRT therapy. [12] [13] [14]
[16]
Chronic Kidney Disease and End Stage Renal Disease in children
Chronic Kidney Disease (CKD) occurs when the function of the kidney is affected
for a period of at least three months, usually accompanied by structural damage
of the kidney and a decreased GFR. According to KDOQI guidelines, a GFR <60
mL/min/1.73m^2 for at least three months is considered CKD. However, patients
with a subnormal GFR of >60 to 89 mL/min/1.73m^2 are at risk for further kidney
function loss and cardiovascular disease.
Indicators or markers of CKD include:
- Proteinuria (more specifically albuminuria), which is determined by the
ratio of the concentration of albumin to creatinine in spot urine. Protein
content in urine varies at different times of the day and proteinuria has
been reported as high as in 10% of normal children but only less than 1%
of these have persistent proteinuria. [36] - Decreased GFR. GFR is the best marker of kidney function and varies
according to age, gender and body size as mentioned before. Adult GFR
levels are reached by 2 years of age. [37] Normally, the GFR is adjusted
to standard body surface area of 1.73 m^2. The average GFR in a week old
neonate is 40-50 mL/min/1.73 m^2 , increasing to 65 mL/min/1.73 m^2 at 1
month of age, 95 mL/min/1.73 m^2 by 2 months of age, and reaches 130
mL/min/1.73 m^2 in the age group of 2 to 12. [37, 38]