Any abnormality of kidney structure as detected by imaging studies or of kidney function as detected by blood or urine tests that persists for more than three months is called CKD. Not all children with CKD have elevated creatinine and not all will progress to renal failure. However, all of them have the potential for progression to renal failure.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), account for more than half the cases of CKD.The three commonest anomalies are posterior urethral valves, vesico-ureteric reflux and hypodsyplastic kidneys. Glomerular disease, neurogenic bladder and hereditary renal diseases are some of the other important causes.  

There are 5 stages of CKD. The classification is based on estimated GFR values. GFR is easily calculated at the bedside if we know the height in centimetres and the serum creatinine in mg /dl. The formula used is eGFR = K x Height/ serum creatinine. The value of the constant K is 0.413.

Stage I has GFR >90 ml/min, stage II has GFR  60-90 ml/min, stage III has GFR of 30-60 ml/min, stage IV has GFR of 15 to 30ml/min and stage 5 also known as end stage renal disease (ESRD) is when GFR is less than 15 ml/min

The following derangements can be present in a child with CKD especially when the child is in CKD 3 or more. Anemia, mineral and bone disease, cardiovascular disease, fluid, electrolyte, acid base disturbances, short stature or failure to thrive may be seen.

The main pillars of treatment are early and adequate treatment of the primary renal disease; evaluation and control of associated comorbidities, metabolic and hormonal derangements. Control of hypertension and proteinuria, dietary modification, complete immunization, avoidance of blood transfusions and monitoring eGFR and proteinuria for evidence of progression.

All children with CKD may not progress to ESRD. The progression to ESRD varies widely depending on the nature of the underlying disease, appropriateness of therapy received, control of comorbidities and the degree of proteinuria. Progression is faster in glomerular diseases compared to children with CAKUT and within any category it progresses faster with worsening proteinuria.

Once the child reaches ESRD with a GFR less than 15 ml/min renal replacement therapy should be started. Technical and psychosocial preparation should start much earlier.

The preferred option for treatment of ESRD is kidney transplantation either from a live or deceased donor. When transplantation is not immediately feasible maintenance dialysis should be instituted and continued until transplantation becomes feasible

All children diagnosed as CKD should be managed under the guidance of and regular supervision by a pediatric nephrologist in order to treat the primary disease adequately to keep the comorbidities under control and for timely plan and institution of renal replacement therapy