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Treatment of chronic kidney disease in children

Korean Journal of Pediatrics 2009;52(10):1061-1068.
Published online October 15, 2009.
Treatment of chronic kidney disease in children
Joo Hoon Lee
Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
소아의 만성신장질환의 치료
울산대학교 의과대학 서울아산병원 소아과학교실
Joo Hoon Lee, Email: pedkid@gmail.com
The treatment of pediatric patients with chronic renal disease comprises management of nutritional imbalance, fluid, electrolyte, and acid-base disturbances, mineral bone disease, anemia, hypertension, and growth retardation. The treatment also includes administration of appropriate renal replacement therapy, if required. Adequate dietary intake of carbohydrates, fats, and proteins and caloric intake must be encouraged in such patients to ensure proper growth and development. In addition, fluid, electrolyte, and acid-base status must be regularly monitored and should be well maintained. Serum calcium, phosphorus, and parathyroid hormone levels must be maintained at their target range, which are determined on the basis of the glomerular filtration rate, to avoid the development of mineral bone disease. This can be achieved by using phosphorus binders and vitamin D analogues. An erythropoiesis-stimulating agent must be administered along with iron supplementation to maintain the hemoglobin level of the patients between 11-12 g/dL. Hypertension must be controlled with adequate water and sodium balance and appropriate antihypertensive agents. Administration of recombinant human growth hormone is recommended to improve the final adult heights.
Key Words: Chronic kidney disease, Children, Treatment, Mineral bone disease, Anemia, Hypertension, Growth hormone

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