4-2). There are various reasons for this decline. One reason is a decrease in infectious diseases that are related to the development of nephritis or improvement of sanitation and social conditions. This is the case especially for the decreasing incidence of acute glomerulonephritis

and membranoproliferative glomerulonephritis. Another reason is that chronic glomerulonephritis has been treated better with drug therapy, including “cocktail” therapy combining corticosteroid, immunosuppressants, and anticoagulation agents. Moreover, tonsillectomy with steroid pulse therapy has recently been reported to improve IgA nephropathy, the disease comprising more than 50% of the cases of chronic glomerulonephritides in Japan (Fig. 4-3). In Fig. 4-3, clinical remission means the disappearance of both proteinuria and hematuria, and thus a remission case is expected to prevent progression to ESKD. selleckchem ��-Nicotinamide Fig. 4-3 Clinical remission rate of IgA nephropathy analyzed by serum creatinine at tonsillectomy followed by steroid pulse therapy. The data are quoted, with modification, from: Hotta O et al. (Am J Kidney Dis. 2001;38:736–743) The incidence of dialysis introduction because of nephrosclerosis, which is caused primarily by hypertension (including malignant hypertension), is still increasing and reached 10.0% in 2007 (Table 4-1).

This increment is suspected to increase more in the future. Conceivably, hypertension is a risk factor for kidney Smoothened dysfunction leading to dialysis in most of the kidney diseases such as diabetic nephropathy and chronic glomerulonephritis. Moreover, there is an increase in atherosclerosis due to metabolic syndrome and elderly populations. Atherosclerosis causes cerebrovascular disease as well as cardiovascular disease and further contributes to the development of CKD. Atherosclerosis-related nephropathy is rapidly increasing with an unfavorable prognosis and manifests as a variety of phenotypes, such as renal artery stenosis, renovascular

hypertension, ischemic nephropathy, and cholesterol embolism.”
“In children, genetic/congenital kidney diseases are more frequent in addition to primary as well as secondary ones. It is therefore important to take the family history as well as past history without omission. Because of the frequent occurrence of postural proteinuria, morning first urine should be tested in pediatric urinalysis. The Japanese eGFR formula cannot be applied for the evaluation of kidney function in children. Notable points in pediatric CKD As described above, the prevalence of genetic/congenital kidney disease is high in pediatric CKD. Diagnostic imaging by ultrasonography is of importance, especially because most kidney diseases are secondary to urinary tract abnormalities. The serum creatinine (Cr) is most noteworthy in the evaluation of pediatric CKD.