Asking the next right question

In the past 20 years, with the use of dialysis and kidney transplantation, there has been great improvement in the care of patients with chronic kidney failure. Improvements in the care still need to be made and the best course of treatment is not certain. There are problems, unique to children, who have chronic kidney failure. Growth in children is impaired because of chronic kidney failure. This problem is compounded because children with chronic kidney failure do not eat as much. An aggressive approach must be taken for the child to receive nutrients, including dietary supplements given through tubes in the stomach or nose, until the child is old enough to undergo kidney transplantation. The youngest age that a child can receive a kidney transplant without increased risks of rejection has not been determined. Some institutions have had good success rates in very young children. However, data compiled by the North American Pediatric Renal Transplant Cooperative Study on over 1,200 kidney transplants in children from various institutions in North America, show that graft rejection is greater in infants younger than two years old. With new biological products now available through recombinant DNA technology, treatment of children with kidney disease has improved. The administration of erythropoietin, a hormone that causes maturation of red blood cells and corrects anemia, improves appetite. Preliminary studies show that the administration of human growth hormone results in increased growth of children with chronic kidney disease. Other studies show that children who are on dialysis for long periods of time do not have a better rate of survival of the kidney transplant than children who have not been on dialysis for long periods of time. This differs from the case with adults, where those on dialysis for long periods of time have better survival rates of kidney grafts compared with those not on dialysis. Thus, with new options available, the best approach for treatment of children with kidney failure must be further analyzed. (Consumer Summary produced by Reliance Medical Information, Inc.)