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Aim: Previous studies on progression of chronic kidney disease (CKD) in children have included older post‐pubertal subjects. This study attempted to evaluate risk factors for progression of CKD in pre‐pubertal children. Methods: An observational study of children aged 2–10 years with an eGFR within the limits of >30 and <75 mL/min/1.73 m2 was performed. Presenting clinical and biochemical risk factors, as well as diagnosis, were analysed for their association with progression to kidney failure, time to kidney failure and for the rate of decline of kidney function. Results: One hundred and twenty‐five children were studied of whom 42 (34%) had progressed to CKD stage 5 during the median period of follow up of 3.1 (IQR = 1.8–6) years. Hypertension, anaemia and acidosis at entry were associated with progression but they did not predict reaching the end point. Only glomerular disease, proteinuria and stage 4 kidney disease were independent predictors of kidney failure and the time to kidney failure. The rate of kidney function decline was greater in patients with glomerular than non‐glomerular disease. Conclusions: Common modifiable risk factors, when present at initial evaluation, were not independently associated with CKD progression to kidney failure in prepubertal children. Only non‐modifiable risk factors and proteinuria predicted eventual stage 5 disease. The physiological changes of puberty may be the major precipitator of kidney failure during adolescence. Summary at a Glance: We investigated risk factors at presentation for progression of chronic kidney disease in a cohort of prepubertal children. Common modifiable clinical factors hypertension, anaemia and acidosis did not predict kidney failure. Proteinuria, stage 4 CKD and glomerular disease were associated with progression and a shorter time to failure. [ABSTRACT FROM AUTHOR]

The article discusses the importance of examination of the urine in investigating acquired renal disease in children. Examination of the urine should be used in cases involving post-infectious glomerulonephritis, nephrotic syndrome (NS) and diarrhoea-associated haemolytic uraemic syndrome. The need for special investigations to confirm the diagnosis and to rule out infections or underlying immune-mediated forms of glomerular diseases causing secondary NS is suggested.

The article reports on paediatric kidney diseases in South Africa. These diseases include the common congenital abnormalities of the kidney and urinary tract and acute acquired disorders presenting with oedema and or hypertension, and positive urine findings. The need to recognise kidney disease early enough to prevent progression to end-stage disease is highlighted due to lack of access of few children to dialysis or renal transplantation.

The article presents answers to a quiz on the case of an African child with systemic hypertension.

A quiz on the case of a female toddler who was referred to physicians with the problem of hypertensive encephalopathy which manifested with convulsions, right hemiparesis and blindness is presented.