Chronic kidney disease and progression

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Target exams

Red flags

• A child whose growth crosses centile lines downward while carrying a known kidney abnormality
• Rising creatinine with new or worsening hypertension and proteinuria signalling accelerated progression
• Unexplained anaemia, metabolic acidosis or failure to thrive that is revealed to be chronic kidney disease
• Hyperkalaemia, fluid overload or uraemic symptoms in advanced CKD threatening acute decompensation
• Severe secondary hyperparathyroidism or hyperphosphataemia driving mineral-bone disease and vascular risk
• Late presentation of bilateral cystic or dysplastic kidneys with eGFR already in the kidney-failure range

Life stages

Care settings

Clinical exam formats

Board mappings

• Defines chronic kidney disease and applies the KDIGO GFR and albuminuria staging grid
• Recognises growth failure, hypertension and anaemia as presenting features of CKD in children
• Initiates nephroprotective care with blood-pressure control and early nephrology referral
• Explains the hyperfiltration vicious cycle and the evidence for ACE inhibitor or ARB therapy to slow progression
• Justifies blood-pressure targets below the 50th percentile and interprets ambulatory blood-pressure monitoring
• Coordinates longitudinal management of growth, anaemia, acidosis and mineral-bone disease toward transplantation
• KDIGO definition and G1 to G5, A1 to A3 staging of chronic kidney disease
• Common paediatric causes including CAKUT and the principle of progression
• Nephroprotective bundle and when to escalate to a specialist centre
• Long-case assessment of a child with established CKD including growth, blood pressure and complications
• Counselling families on prognosis, dialysis versus transplantation and transition to adult care
• Recognising and managing acute decompensation of chronic kidney disease
• Level 1: Recognises CKD as kidney abnormalities present for over three months and identifies high-risk presentations
• Level 2: Applies KDIGO staging and initiates nephroprotection with blood-pressure and proteinuria control
• Level 3: Leads the multidisciplinary management of complications and preparation for kidney replacement therapy
• KDIGO GFR categories G1 to G5 and albuminuria categories A1 to A3
• Bedside Schwartz formula for estimating GFR in children
• Mechanism of CKD progression and the role of renin-angiotensin system blockade
• Assessment of growth, blood pressure and fluid status in a child with CKD
• Interpretation of anaemia, acidosis and mineral-bone markers across CKD stages
• Structured explanation of the management ladder from nephroprotection to transplantation
• Definition and staging of chronic kidney disease in children using KDIGO criteria
• Identification and initial management of progression risk factors
• Recognition and treatment of CKD complications including anaemia and mineral-bone disorder
• Defines CKD and distinguishes it from acute kidney injury
• Initiates nephroprotective therapy and timely nephrology referral
• Monitors growth, blood pressure and complications across the CKD trajectory
• Canadian approach to CKD classification and the GFR and albuminuria grid
• Blood-pressure targets and renin-angiotensin blockade in paediatric CKD
• Coordination of transition from paediatric to adult nephrology services