This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. By 2010, it has been estimated that 650,000 Americans will have ESRD at a cost of $28 billion per year. Because the increase of CKD has been most dramatic in the adult population, few studies have been performed in children with CKD. However, because of the importance of growth and neurocognitive development in the pediatric age group, children are likely to be much more vulnerable to the effects of progressive CKD than adults. Additionally, as kidney disease is usually due to a primary urologic problem or glomerular disease rather than a secondary process such as diabetes or hypertension (WTN), as in adults, the risk factors and consequences of kidney disease progression, independent of other complicating factors, are likely to be clearer in children. If the current estimate of 3 to 5 ml/min/year for the rate of decline in kidney function among adult patients with CKD is correct [Hunsicker 1997, NAPRTCS 2002, Wright, Jr. 2002], then many young adults with end stage kidney disease had the genesis of their CKD in childhood or adolescence. Most children with CKD have congenital urologic disease or inherited disorders. The most common causes of pediatric CKD are: obstructive uropathy, renal dysplasia, reflux nephropathy and focal segmental glomerulosclerosis [NAPRTCS 2002]unlike adults who have completed their physiological and intellectual maturation, infants and children are at the early stages of their developmental processes and are particularly vulnerable to the adverse effects of chronic disease.
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