Chiu Man-Chun

Renal failure can be categorised into several degrees: renal insufficiency refers to GFR between 25 - 50% of normal, severe renal failure to less than 25% whereas end-stage renal failure to less than 10% and requires some form of renal replacement therapy. Chronic renal failure denotes severe renal failure of more than 6 months duration.

Chronic renal failure affects homeostasis of the body greatly, leading to many complications, like electrolytes and fluid disturbance, anaemia, renal osteodystrophy, growth failure, developmental delay and neurological dysfunction, hypertension and psychological maladjustments.

For those entering into ESRD, renal replacement therapy e.g. dialysis and renal transplantation are required to maintain life. Dialysis can be in the form of peritoneal dialysis or haemodialysis. Continuous ambulatory peritoneal dialysis (CAPD) had been the most popular mode of PD in the 80s for children; however with the introduction of an automated peritoneal dialysis machine, CAPD can be done at night automatically using the machine, saving the child and patents time of doing dialysis during daytime, and has been widely used in the 90s.

Transplantation is the best mode of renal replacement therapy. With the introduction cyclosporin A as an immunosuppressant, the result of graft survival has been greatly improved. Other factors that affect success rate include HLA matching, age of donor and recipient, cold ischaemic time and source of donor (cadaveric or living-related).

The incidence of ESRD in children below 15 yr in Hong Kong was estimated to be 4.0 per million children population. In analyzing 28 chronic renal failure children seen at Princess Margaret Hospital, there were 20 boys and 8 girls, of a mean age of 13.0 yr (3 - 21 yr). Causes include chronic glomerulonephritis 11(39%), dysplastic/ hypoplastic kidneys 7 (18%), reflux/obstructive uropathy 5 (18%), vascular nephropathy 3 (11%), others or undetermined 2 (7%). 18 of them were ESRD, of which 9 (50%) were on automated peritoneal dialysis, 2 on CAPD (11%), 4 on haemodialysis (22%), and 3 transplanted (17%). Those put on dialysis had been on the treatment for 25.2 months (1 - 89 mons). Automated peritoneal dialysis has improved the quality of life of these children, but transplantation remains the best therapy that can be offered to these children.