title: National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification.
abstract: OBJECTIVE
  A series of new guidelines has been developed by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative to improve the detection and management of chronic kidney disease (CKD). In most instances of CKD, the earliest manifestations of the disorder may be identified by relatively simple tests. Unfortunately, CKD is often "underdiagnosed," in part because of the absence of a common definition of CKD and a classification of the stages in its progression. The Kidney Disease Outcomes Quality Initiative clinical practice guidelines for CKD evaluation, classification, and stratification provide a basis to remedy these deficits. The specific goals of the guidelines described in this review are to provide: 1) an overview of the clinical practice guidelines as they pertain to children and adolescents, 2) a simple classification of the stages of CKD, and 3) a practical approach to the laboratory assessment of kidney disease in children and adolescents.
  
  
  METHODS
  The guidelines were developed as part of an evidence-based evaluation of CKD and its consequences in patients of all ages. The data that were used to generate the guidelines in this article were extracted from a structured analysis of articles that reported on children with CKD.
  
  
  CONCLUSIONS
  This review presents the definition and 5-stage classification system of CKD developed by the work group assigned to develop the guidelines, and summarizes the major recommendations regarding the early detection of CKD. Major emphasis is placed on the identification of children and adolescents with CKD by measuring the protein-to-creatinine ratio in spot urine specimens and by estimating the glomerular filtration rate from serum creatinine using prediction equations.
authors.affiliation: North Texas Hospital for Children and the Department of Clinical Research at Medical City Dallas Hospital, Dallas, Texas 75230, USA. spnsg@lonestarhealth.com
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Hogg
authors.forename: Susan
authors.initials: S
authors.lastname: Furth
authors.forename: Kevin V
authors.initials: KV
authors.lastname: Lemley
authors.forename: Ronald
authors.initials: R
authors.lastname: Portman
authors.forename: George J
authors.initials: GJ
authors.lastname: Schwartz
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Ethan
authors.initials: E
authors.lastname: Balk
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.forename: Annamaria T
authors.initials: AT
authors.lastname: Kausz
authors.forename: Garabed
authors.initials: G
authors.lastname: Eknoyan
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000145:classification / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*; D008297:Male; D011507:Proteinuria / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D011785:Quality Assurance, Health Care / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome