Published in:
01-06-2018 | Editorial Commentary
A plea for more uremic toxin research in children with chronic kidney disease
Published in: Pediatric Nephrology | Issue 6/2018
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Progressive loss of kidney function in childhood is paralleled by the development of a complex clinical picture, also referred to as the pediatric uremic syndrome. This syndrome, caused by chronic kidney disease or acute renal injury, is affecting nearly all organ systems (Table 1), and consequently, results in a significantly decreased quality of life and increased mortality during, and also beyond, childhood [1‐3]. The complexity of the uremic syndrome is also related to its multifactorial character: due to (1) the deterioration of the renal endocrine function (e.g., erythropoietin and calcitriol deficiency), (2) the dysregulation of fluid and electrolyte homeostasis, (3) the development of specific symptoms related to kidney disease (hypertension, fluid overload) and its causes (e.g., diabetes, autoimmune disorders) or (4) treatment (e.g., reactions to bioincompatible dialysis materials), and (5) the accumulation of toxic organic metabolites (i.e., “uremic toxins”) due to decreased renal excretion and/or accompanied by increased toxin generation (Fig. 1) [4, 5]. Without neglecting the multifactorial character of the uremic syndrome, this editorial commentary will focus mainly on the accumulation of uremic toxins and its impact within the pediatric uremic syndrome.
Table 1
Symptoms, characteristics, and complications of the pediatric uremic syndrome. The symptoms, characteristics, and complications highlighted in bold with mark of (*) al features unique for the pediatric uremic syndrome
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Fluid and electrolyte balance: polyuria, polydipsia, fluid overload, hypertension, oligo-anuria, metabolic acidosis, hyperkalemia, hyperphosphatemia, hypocalcemia
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Endocrine and hormonal system: growth hormone resistance*, insulin resistance, thyroid dysfunction, hyperaldosteronism, adipokine dysbalance, pubertal delay*, anorexigenic hormones increase
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Bone and soft tissue: disordered bone turnover and mineralization, bone pain, fractures, growth retardation*, vascular and soft tissue calcifications, rickets*, active vitamin D deficiency, hyperparathyroidism, FGF-23 excess, Klotho deficiency
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Hematological system: anemia, erythrocyte fragility, susceptibility to infection, low response to vaccination, inflammation, hypercoagulability, bleeding tendency, bone marrow inhibition
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Gastrointestinal system: anorexia, nausea, vomiting, gastropareses, slow gastrointestinal motility, altered taste
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Neurological system: polyneuropathy, coordination disturbances, tremor, cognitive dysfunctions, decreased attention span, coma, lethargy, disturbed sleep pattern
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Skin and mucosa: skin atrophy, pruritus, calciphylaxis, periodontitis, stomatitis
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Cardiac system: left ventricle hypertrophy, cardiomyopathy, pericarditis, coronary calcifications
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Psychosocial factors: school absenteeism*, low quality of life, parental stress and burn out*
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Others: malnutrition, muscle weakness, changes in drug protein binding
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Fig. 1
Presentation of the multifactorial origin of the pediatric uremic syndrome
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