Adult perspective of childhood disease: chronic renal failure

Abstract 

The ideal treatment for a child approaching end-stage renal failure is a pre-emptive renal transplant from a well-matched living donor. Often, this is neither practical nor possible because of late referral to a paediatric nephrologist. Early intervention provides opportunities for delaying progression of renal failure and treating important complications such as growth retardation and anaemia. When dialysis is necessary, aggressive nutritional support, attention to renal bone disease and use of growth hormone together with intensive psychological and social support are the cornerstones of therapy. Excellent human leukocyte antigen matching for cadaveric renal transplantation should be the goal, and with new UK national organ allocation rules, this could be achieved in the majority of cases. New immunosuppressive agents provide a greater choice of regimes that can be tailored to minimize cosmetic side-effects in this vulnerable group of patients. Transfer to the adult nephrologist needs to be managed with sensitivity and care.

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