End stage renal disease in children: diagnosis, management, and interventions.

Chronic irreversible renal failure affects not only the child but the entire family. Physical, psychosocial, and financial challenges must be met and overcome. The primary goal is for the child to grow and develop as normally as possible, receiving the modality of treatment to best achieve this goal, with the fewest complications. Renal assessment includes a thorough history and physical exam, laboratory and radiological testing, and possibly a kidney biopsy. Causes of renal disease in children include congenital or genetic anomalies or conditions acquired after birth. When normal renal functions are impaired, clinical manifestations develop. Progression of chronic renal failure relates to the amount of glomerular filtration rate (GFR) remaining, and follows four stages, from early failure without symptoms, to end stage renal disease (ESRD) with many clinical symptoms of varying severity. In the final stage, renal replacement therapy by peritoneal dialysis, hemodialysis, or renal transplantation is necessary to sustain life. Nursing goals and interventive measures include maintaining fluid, electrolyte, and acidbase balance, and blood pressure control; promoting adequate nutrition, growth, and development; preventing complications related to progressive renal failure or treatment modality; and providing educational and psychosocial support to the child and family.