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CHRONIC RENALFAILUREChronic renal failure (CRF) is definedas an irreversible reduction in GFR.The prevalence of CRF in the pediatric population isapproximately 18 per 1 million. The prognosis for the infant, child, or adolescent with CRF has improved dramatically overthe past 4 decades because of improvements in medical managementaggressive nutritional supportrecombinant erythropoietinrecombinant growth hormone, dialysis techniquesrenal transplantation.Etiology In children, CRF may be the result ofCongenitalacquiredinheritedmetabolic renal disease the underlying cause correlates closely with the age of the patient at the time when the CRF isfirst detected. CRF in children younger than 5 yr is most commonly a result of congenital abnormalitiessuch as renal hypoplasia, dysplasia, and/or obstructive uropathy.After 5 yr of age acquired diseases (various forms of glomerulonephritis) AND inherited disorders (familial juvenile nephronophthisis, Alport syndrome) predominate. CRF related to metabolic disorders (cystinosis, hyperoxaluria) and certain inheriteddisorders (polycystic kidney disease) may present throughout the Ghildhood yearsPATHOGENESIS. IN CHRONIC RENAL FAILURE renal injury may progress despite removalof the original insult.Hyperfiltration injury may be an important final common pathway of glomerular destruction it is independent of the underlying ...


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