By David Thomas, Patrick G. Duffy, A.M.K. Rickwood

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The onset of a limp should be thoroughly evaluated because of the prevalence of slipped femoral epiphysis; indeed, all epiphyses can be affected and fractures can occur. Skeletal deformity is a significant feature of longstanding untreated CRF in children, with the patterns of deformity being age-related. e. rachitic rosary, metaphyseal widening at the wrist and ankle, craniotabes and frontal bossing. qxd 2/29/2008 7:01 PM Page 21 Renal physiology and renal failure GFR Phosphate 1α-Hydroxylase H+ 21 joints, junction of the metaphysis and diaphysis of long bones, and the phalanges.

Qxd 2/29/2008 7:01 PM Page 22 22 Essentials of paediatric urology sterols have been used to control secondary hyperparathyroidism, including dihydrotachysterol, 25-hydroxyvitamin D3, 1α-hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3. 1 μg/ kg/day, it is both safe and effective. Hypercalcaemia is the main side effect, but calcium levels will fall in response to a temporary reduction or cessation of therapy. the treatment of anaemia associated with CRF or ESRD in children. The benefits include: • correction of the anaemia of renal failure, improvement in tissue oxygenation, exercise tolerance and haemostatic activity • improved myocardial function resulting from reduction in the ventricular hypertrophy associated with anaemia • reduced risk of developing HLA antibodies by obviating the need for blood transfusion.

Calculated energy intake may need to be increased in children Disorders of mineral metabolism in children with CRF invariably affect skeletal growth and development, with resultant bone deformities and, in most cases, deceleration of linear growth. The crucial roles played by the kidney in bone and mineral homeostasis include: • regulating calcium, phosphorus and magnesium metabolism • participating in the catabolism of parathyroid hormone (PTH) • excreting aluminium and β2-microglobulin • synthesizing calcitriol or 1,25-hydroxyvitamin D3.

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