Pediatric Renal Physiology, Transplantation, and Hypertension
Core concepts
Understand developmental renal physiology: glomerular filtration rate is low at birth and matures over the first years, affecting drug dosing and fluid management. Know the principles of pediatric kidney transplantation: indications, timing, donor selection, and immunosuppression. Recognize complications such as rejection, infection, and urologic complications (ureteral stricture, reflux). Understand hypertension in children: definitions based on age, sex, and height percentiles, causes (renal parenchymal disease is most common), and evaluation. Know the role of ambulatory blood pressure monitoring and the treatment of hypertension in children with chronic kidney disease. Recognize the relationship between congenital anomalies of the kidney and urinary tract and chronic kidney disease.
Traps
- Using adult GFR norms in neonates.
- Forgetting that renal parenchymal disease is the most common cause of pediatric hypertension.
- Missing urologic complications after transplant.
- Overlooking the need for age- and height-specific blood pressure norms.
Worked example
A child with a solitary functioning kidney and hypertension should be evaluated for renal parenchymal disease and monitored for proteinuria and declining GFR.
Rule of thumb
Pediatric blood pressure must be interpreted against age, sex, and height percentiles; renal disease is the leading secondary cause.