Chronic kidney disease (CKD) has been suggested to affect 15–74.7 children per mil-lion globally. Although CKD is relatively rare in children as compared with adults, hypertension (HTN), obesity and metabolic syndrome, uric acid disturbances is highly prevalent. The prevalence of HTN, obesity and metabolic syndrome is tenfold higher than in the general pediatric population and known to increase as children progress through the stages of CKD, so that by the time they are on dialysis. CKD HTN, obesity, metabolic syndrome and uric acid metabolism are intrinsically linked. Thus, decreased kidney function may be directly related to increased BP, overweight and metabolic syndrome. There are now many studies demonstrating an interaction between CKD and HTN, overweight and metabolic syndrome likely hastening the progression of CKD toward end-stage renal disease. Addressing HTN, overweight and obesity may well prevent or abrogate this decline in renal function and have, therefore, become imperative in the management of CKD. As well as being an associated feature and complication of CKD, and independent risk factors for CKD progression, HTN, obesity, metabolic syndrome and disturbances of uric acid metabolism also contributes to cardiovascular mortality in these children.
Adopting best practices for monitoring and controlling body weight, BP are crucial to improve the management of obesity, HTN, and prevent future end-organ damage. However, diagnosing and managing HTN and obesity in pediatric CKD patients remains a challenge. When obesity and HTN are diagnosed, antihypertensive drugs, including angiotensin converting enzyme (ACE) inhibitors, antiobesity medications such as orlistat might offer renoprotection and delay the progression of CKD, especially in proteinuric states. Dietary restriction and monitoring is also a factor in managing obesity and HTN, but has proved difficult to control in the pediatric population.
To study the role of hypertension, obesity, metabolic syndrome and uric acid disturbances in progression of chronic kidney disease in children.
Pages: 109-116 Published Online: Mar. 10, 2020
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