Clinical Presentation of Renal Disease in Children: The Role of the Pediatrician and Primary Care Physician

Renal disease is a major cause of morbidity in children. Early diagnosis and treatment of renal disease in children is crucial in the prevention of chronic kidney disease (CKD). Because many causes of CKD in children, such as congenital anomalies of the kidney and urinary tract and urinary tract infection are potentially preventable, early diagnosis and treatment of these conditions are of utmost importance. Pediatricians and primary care physicians should be familiar with the modes of presentation of various renal diseases in children, and should have a high index of suspicion in patients with asymptomatic disease. Patients with renal disease may present with (1) congenital anomalies of the kidney and urinary tract (CAKUT), (2) signs and symptoms of renal disease, (3) abnormal urinalysis, (4) urinary tract infection, (5) water, electrolyte and acid-base disturbances, (6) glomerular disease, (7) renal tubular disorders, (8) hypertension, (9) renal manifestations of systemic disease, and (10) decreased renal function. Depending on their comfort level, pediatricians and primary care physicians may start the assessment and treatment of pediatric renal disease. Patients who require teamwork or invasive studies, those with severe renal disease or decreased renal function, and those with parental anxiety should be referred to a pediatric nephrologist.