Chronic kidney disease in children: an update

Chronic kidney disease (CKD) is a major healthcare issue worldwide. However, the prevalence of pediatric CKD has never been systematically assessed and consistent information is lacking in this population. The current definition of CKD is based on glomerular filtration rate (GFR) and the extent of albuminuria. Given the physiological age-related modification of GFR in the first years of life, the definition of CKD is challenging per se in the pediatric population, resulting in high risk of underdiagnosis in this population, treatment delays and untailored clinical management. The advent and spreading of massive-parallel sequencing technology has prompted a profound revision of the epidemiology and the causes of CKD in children, supporting the hypothesis that CKD is much more frequent than currently reported in children and adolescents. This acquired knowledge will eventually converge in the identification of the molecular pathways and cellular response to damage, with new specific therapeutic targets to control disease progression and clinical features of children with CKD. In this review, we will focus on recent innovations in the field of pediatric CKD and in particular those where advances in knowledge have become available in the last years, with the aim of providing a new perspective on CKD in children and adolescents. Lay Summary Chronic kidney disease (CKD) is a devastating disease for which no cure is currently available. Lack of awareness, genetic predisposition and difficulties in measuring kidney function as a tangible sign of CKD in the pediatric population have contributed to delay the identification of effective treatments as well as the causes behind disease progression. In this review, we provide an up-to-date description of the most recent findings in terms of hereditary disorders, pathological mechanisms, novel therapeutic options and nutritional evaluations in children with CKD. We will also discuss the most recent advancements and challenges in effectively determining kidney function in young patients. Collectively, we aim to provide a novel perspective on CKD in children to boost the translation into clinical practice of the most recent discoveries.