Rizično dijete za kroničnu bubrežnu bolest u primarnoj zdravstvenoj zaštiti – koga ne smijemo propustiti?

Chronic kidney disease in children may remain clinically silent for a prolonged period, making early recognition of children at increased risk an important task in primary health care. The risk of kidney disease may originate during fetal development and may be increased by prematurity, low birth weight, congenital anomalies of the kidney and urinary tract, including a solitary kidney, previous acute kidney injury, nephrotoxic exposure, and metabolic, systemic, or genetic disorders. Particular attention should be paid to children with persistent proteinuria and/or albuminuria, hematuria, arterial hypertension, nephrolithiasis or nephrocalcinosis, impaired growth, electrolyte or acid–base abnormalities, and a positive family history of kidney disease.Assessment of kidney risk should not rely solely on serum creatinine or estimated glomerular filtration rate, as structural and/or functional kidney abnormalities may be present despite preserved filtration. The aim of assessment in primary health care is therefore to identify children at increased risk before a measurable decline in kidney function occurs. A systematic approach that includes a targeted medical history, accurate blood pressure measurement, urinalysis, growth monitoring, and recognition of established risk conditions enables timely diagnostic evaluation and referral to a pediatric nephrologist. The practical approach in primary care can be summarised as follows: medical history + blood pressure + urine analysis + growth and development + recognition of risk conditions.