The kidneys perform a variety of functions to maintain health and promote normal growth and development in children. 其中一个核心功能就是过滤血液, to both maintain normal concentrations of certain electrolytes (like sodium and potassium) and minerals (like calcium and phosphorus), and to eliminate certain substances that at high levels could be harmful. 在正常情况下, an infant is born with 2 kidneys and each kidney has approximately 1 million filters (known as nephrons or glomeruli).  然而, some children are born with a significantly reduced number of filters and others, 原因有很多, 这些过滤器遭受永久性损坏. 这些儿童患有慢性肾脏疾病(CKD). 慢性肾病可分为轻度、中度和重度. 然而, it is progressive, meaning that the degree of reduced kidney function gets worse over time. The rate of decline though varies greatly from person to person, often depending upon the cause. Some persons progress from mild CKD to dialysis in a matter of months, 而另一些则需要几年甚至几十年.

肾脏的作用

• 清洗血液, 包括清除废物, 毒素, 额外的液体和维持适当的化学平衡.
• Regulating vitamin D and the concentration of calcium and phosphorus in the blood. The kidneys thus make sure bones are strong and grow properly.
• 调节对正常生长很重要的激素.
• 调节血压.
• Produce a hormone that regulates the production of red blood cells.

因此, 患有慢性肾病的儿童可能会有生长问题, 高血压, 贫血, 骨骼发育异常.

如何测量肾功能?

Kidney function is usually measured by monitoring the concentration in blood of a substance called creatinine. Creatinine is produced by normal metabolism of muscle and is not toxic. 然而, it is only eliminated from the body by the kidneys and thus its concentration in blood can be used to estimate how well the kidneys are eliminating waste.

慢性肾病有哪些阶段

The normal concentration of creatinine in blood varies by age and this concentration can be used to estimate the glomerular filtration rate (GFR), a measurement of how effectively the kidneys are filtering blood.

1. Stage 1 CKD (GFR > 90): 肾脏受损，但肾功能正常. 病人 at this stage sometimes have hypertension but generally have no other symptoms.
2. 2期CKD (GFR 60-89): 在这个阶段, abnormalities in blood phosphorus and a hormone related to bone metabolism (parathyroid hormone or PTH) may be seen. 可能需要改变饮食. 有些孩子可能表现出生长缓慢.
3. 3期CKD (GFR 30-59): Anemia often develops and problems with bone metabolism worsen.
4. 4期CKD (GFR 15-29): High potassium and accumulation of acids in the blood may be seen.
5. Stage 5 CKD (GFR < 15): 需要或接近需要透析或肾移植的患者.

How Will CKD Affect My Child’s Life and What 治疗s Will Be Necessary?

As noted, only children with advanced CKD will feel tired or have other significant symptoms. Children with CKD must visit their pediatric nephrologist on a regular basis and have blood and urine testing. Changes in kidney function that require modifications in diet or start of medication are usually only evident with blood work results. 幸运的是, the problems that do develop all have treatments that allow children with CKD to lead active lives and remain healthy as kidney function declines. 这些问题及其治疗方法包括:

• 增长: 一些患有慢性肾病的儿童不能很好地生长或增加体重. 在某些情况下，医生会开营养补充剂. If growth rate is very slow, growth hormone may be prescribed. Growth hormone is given as a shot under the skin (much like an insulin shot) once a day.
• 骨的问题: 钙和磷使骨头变得坚硬. The kidneys help regulate the amount of calcium and phosphorus in the blood. 特别是, CKD的早期阶段, phosphorus can build up to higher than normal levels and impair normal development of the bones. 许多食物中都含有磷, 尤其是乳制品, and children with CKD are usually asked to follow a diet low in phosphorus. As CKD advances, phosphorus will build up even with a low phosphorus diet. 因此, children with advanced CKD are usually prescribed medication to take with meals that partially binds the phosphorus in their food. Finally, as CKD worsens, children with CKD are usually prescribed a special kind of vitamin D.
• 酸积累: Proteins in diet are broken down by the body and this process produces a small amount of acid. 肾脏会清除这些酸, and as CKD worsens these can build up and affect growth and normal bone development. 结果是, some children with CKD will be prescribed bicarbonate medication to neutralize these acids.
• 高血压: The kidneys are a prime regulator of the blood pressure and some children with CKD will develop hypertension. A low salt diet and blood pressure medication may be prescribed.
• 贫血: 肾脏产生一种激素(促红细胞生成素), also known EPO) that regulates the body’s production of red blood cells. CKD进展的儿童经常会出现贫血. 幸运的是, 促生成素可以皮下注射, 通常每周一次或隔周一次.
• 透析或肾移植: 当儿童达到CKD 5期时, dialysis or kidney transplant will be necessary to maintain optimal health. The goal of every child with stage 5 CKD is a kidney transplant, though approximately 75% of children first have a course of dialysis as they prepare and await a transplant.

你的团队

A team of professionals is available to help you and your child with CKD. 这些包括:

• 儿童肾病
• 小儿肾脏学 Nurses: As children with CKD reach stage 3, 他们和他们的家人都有资格获得Reach肾脏护理. Reach Kidney Care is a free program that helps with education and planning.
• 注册肾脏营养师
• Renal Social Worker: The process of CKD can be emotional for children and their families. 经济和其他负担可能会使这一点变得更加困难. Social work assistance is available and almost universally invaluable. Often children and families benefit from counseling support and the renal social worker can help identify appropriate local resources.