End-stage renal disease (ESRD) is a major cause of morbidity and mortality in the adult population. Additionally, the burden on patients and the healthcare system is vast. Patients suffering from ESRD are dependent on dialysis in order to filter out toxic metabolites in their blood. This treatment is both cumbersome and time-consuming. Given these conditions, prevention of ESRD should be a major focus of the healthcare field, with screening and treatment initiated in adolescence. However, the correlation between diseased states of the kidney presenting in childhood and progression to ESRD has not been studied or well-established.

The authors of a recently published article sought to determine whether a history of renal disease in childhood correlates with an increased risk of ESRD later in life. A historical cohort study was conducted, which included a total of 1,521,501 patients who had normal renal function and no hypertension in adolescence. Results of the study indicated that renal disease in childhood.  Among them, congenital anomalies, pyelonephritis as well as glomerular disease all conferred an increased risk of developing ESRD at an earlier age in adulthood. The associated risk was about the same for each of the aforementioned childhood renal diseases. The authors conclude that any history of kidney pathology in childhood, even if not associated with impaired renal function, leads to a significantly elevated risk of ESRD and that perhaps kidney injury or structural derangements confer long-term consequences.

Thus, children presenting to their pediatricians with kidney disease should be followed on a regular basis in order to monitor for any derangements in renal function over time. This will likely delay or prevent progression to ESRD, allowing for lower overall morbidity and mortality. Physicians should note that even with complete resolution of particular renal diseases in adolescence, the risk for ESRD is not eliminated, and patients and their families should be educated on this basis.

Ronit Calderon-Margalit, M.D., M.P.H., Eliezer Golan, M.D, et al.