The most common causes of end-stage renal disease (ESRD) in children are congenital, cystic, and hereditary diseases, which combined account for 38% of incident cases. The most common disorders in this category are congenital obstructive uropathies (9.5%) and renal hypoplasia/dysplasia (10%). Primary glomerular disease is the second-most common etiology accounting for 25% of new cases, predominantly due to focal segmental glomerulosclerosis (FSGS). Secondary glomerulonephritis and vasculitis account for 12% of new cases, of which lupus nephritis is the most common. The underlying etiology of ESRD also varies by age of presentation. As expected, congenital/hereditary/cystic disorders are the most common underlying cause of ESRD amongst the youngest age groups, while primary and secondary glomerular diseases are the leading cause among adolescents.
Kidney transplantation is the preferred treatment for ESRD in children and confers improved survival, skeletal growth, heath-related quality of life, and neuropsychological development compared to dialysis.
Transplantation is initially considered when renal replacement therapy is imminent. Due to increased risk of graft loss and mortality in very young children, most pediatric centers perform kidney transplantation once children achieve a weight above 10–15 kg, which is typically around the age of 2 years. The underlying etiology for kidney failure, the rapidity of decline in kidney function, and the age and size of the patient determine whether an individual can receive a pre-emptive kidney transplant without preceding dialysis, which may provide a graft survival advantage. On average, 30% of pediatric kidney transplant recipients in the U.S. receive pre-emptive transplant, and an additional 24% receive dialysis treatment for less than 1 year prior to transplant.
