Manual of Pediatric Nephrology Kishore Phadke • Paul Goodyer Martin Bitzan Editors Manual of Pediatric Nephrology Editors Kishore Phadke Martin Bitzan Department of Pediatric Nephrology Division of Pediatric Nephrology Children’s Kidney Care Center Montreal Children’s Hospital St. John’s Medical College Hospital McGill University Bangalore, KA Montreal , QC India Canada Paul Goodyer Division of Pediatric Nephrology Montreal Children’s Hospital McGill University Montreal, QC Canada ISBN 978-3-642-12482-2 ISBN 978-3-642-12483-9 (eBook) DOI 10.1007/978-3-642-12483-9 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013948392 © Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword I The International Society of Nephrology strives to improve access to the best possible kidney care worldwide. An important step is the training of nephrologists and physicians treating patients with renal diseases. These goals form the basis of the ISN “Global Outreach” (GO) programs – to build health equality worldwide and improve kidney care and prevention strategies around the globe by making the knowledge and experience of the developed world accessible to kidney doctors and other specialists in emerging countries. Children are a particularly vulnerable population. Unacceptable delays in the recognition and treatment of (severe) renal disease due to lack of access to basic and comprehensive care often leads to preventable, acute and chronic adverse effects caused by malfunctioning kidneys. Kidney disease during infancy to adolescence due to (intrauterine) malnutrition, genetic inheritance, nephrotoxic agents or poorly treated primary diseases has devastating, often irreversible, effects on bone health, growth and intellectual development. Disparities in preventive and curative or supportive care arise from the lack of knowledgeable health care professionals, lack of (public) health care resources and lack of individual fi nancial means to initiate and support therapies that are taken for granted in more affl uent countries. To come to grips with the global challenge of rising numbers of patients with renal diseases, the ISN created the Sister Renal Center program pairing emerging and supporting (established) centers across all continents. As the chair and ardent supporter of our GO programs, I am proud to witness the involvement of dedicated pediatric nephrologists in this endeavor. This Manual is the collaborative product of one of the few and successful pedi- atric sister center pairs, the Children’s Kidney Care Center at the St. John’s Medical College Hospital in Bangalore, India, and the Nephrology Division at the Montreal Children’s Hospital in Montreal, Canada. Written in a collaborative spirit, it empha- sizes a global perspective. May it serve health care professionals, trainees, and physicians to improve the diagnosis and treatment of children with renal diseases worldwide. Paul N. Harden Professor of Nephrology Chair, International Society of Nephrology Sister Renal Program Oxford, UK v Foreword II Today, kidney issues dramatically impact global health, especially the health of children. In developing countries, millions of people – most of them children – die each year from diseases that are preventable and treatable. For many of these chil- dren, kidney problems represent a serious threat to their survival. Important examples include – but are not limited to – the delayed recognition and treatment for congenital abnormalities of the kidney and urinary tract, which are a major cause of chronic kidney disease and secondary health problems; severe fl uid and electrolyte disturbances and acute kidney injury due to diarrhea, the #2 cause of death in children worldwide; infants with low birth weight in low income groups due to malnutrition and lack of prenatal care, with an increased risk of small kid- neys, hypertension in adolescence and chronic kidney disease; HIV associated nephropathy, particularly in areas where highly active antiretroviral therapy is not accessible. A major goal of the International Pediatric Nephrology Association (IPNA) is to reach physicians throughout the world through educational and fellowship programs and enable them to care for children with kidney diseases. This Manual of Pediatric Nephrology is designed to give pediatrician and general physicians as well as train- ees and other health care professionals a quick and practical approach to the diag- nosis and treatment of children with different types of kidney diseases. The well-structured text is easy to read and covers all important areas in the fi eld. On behalf of IPNA, I welcome this new manual as a valuable resource for prac- titioners and trainees in (pediatric) nephrology alike. Its appeal lies in the combined perspective provided by experienced nephrologists from different continents that takes into account the realities in emerging countries. It corresponds well to IPNA’s goals to “work to disseminate knowledge about kidney disease in children in the areas where care is needed most”. Isidro B, Salusky, M.D. Secretary General IPNA Distinguished Professor of Pediatrics David Geffen School of Medicine at UCLA Los Angeles, CA, USA vii Preface This manual does not want to replace standard textbooks of nephrology or pediatric nephrology. Rather, it offers a fi rst, quick and practical approach for the care of children with kidney disease. It is meant to serve practitioners, trainees, pediatri- cians, general physicians, and other health care professionals. The manual is the product of a long-lasting collaboration between two pediatric nephrology units, the Children’s Kidney Care Center at the Saint John’s Medical College Hospital (St-John’s) in Bangalore, India, and the Division of Nephrology at the Montreal Children’s Hospital (MCH) in Montreal, Canada. The authors approached each chapter with the practical reality in emerging and resource-poor countries in mind. We hope that this concept renders the manual use- ful and versatile in a variety of settings and diverse medical practices. To this end, we are proud of the manual’s endorsement by the International Society of Nephrology Global Outreach initiative and the support by the International Pediatric Nephrology Association. It is unavoidable in a practically oriented, abbreviated book like ours that topics are missing or only mentioned cursorily. The editors purposefully focused on rela- tively frequent and clinically important disorders and practical, mainly diagnostic and therapeutic, aspects. Detailed pathological and pathophysiological reviews were omitted to keep the text short and lean. The reader is strongly encouraged to seek in-depth information in more comprehensive textbooks. The editors appreciate speci fi c suggestions that help improve the utility and ame- liorate the shortcomings of this manual. Please, email the editors your comments. We hope that the global pediatric nephrology community will adopt the manual as a dynamic, interactive project with input from trainees and practitioners alike. The editors have an enduring commitment to research and education in pediatric renal diseases locally and internationally with the ultimate goal of improving chil- dren’s access to renal care – irrespective of monetary resources, societal status, or geography. They are connected through a long-standing collaboration within the ISN Sister Renal Center program. Kishore Phadke, Professor of Pediatrics and Nephrology, Director of the Children’s Kidney Care Center and former Chair of Pediatrics at St-John’s was the driving force behind this manual. He established a successful, internationally recognized Pediatric Nephrology Training Program, whose trainees now work across