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Title of Journal: Pediatr Nephrol

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Abbravation: Pediatric Nephrology

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Springer-Verlag

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DOI

10.1007/bf02345905

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1432-198X

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Uraemic vasculopathy in children with chronic kidn

Authors: Rukshana Shroff Catherine Quinlan Mark Mitsnefes
Publish Date: 2010/11/16
Volume: 26, Issue: 6, Pages: 853-865
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Abstract

Since the inception of pediatric dialysis programmes nearly 50 years ago there have been vast improvements in both the technology and expertise in the care of children with chronic kidney disease CKD Nevertheless children on dialysis continue to have a significantly higher mortality than their healthy peers and cardiovascular disease CVD is the most common cause of death in this group Chronic kidney disease is described as the “perfect storm” of risk factors for CVD development and vascular calcification is a highly regulated cellmediated process with several promoters and inhibitors of calcification CVD begins early in the course of CKD and there is an independent and graded association between cardiovascular morbidity and renal decline Also it is shown that once vascular damage and calcification begin they progress inexorably in the uraemic milieu and may only be partially reversed after successful transplantation Thus preventing the development of CVD is key and early identification and management of specific CVDrelated risk factors should begin from the early stages of CKD While the vasculopathy of childhood CKD is clearly multifactorial clinical epidemiological and cell biology studies provide converging evidence pointing to the role of dysregulated mineral metabolism as an important modifiable risk factor in the development of vascular calcification In this review we focus on the role of calcium phosphate parathyroid hormone and vitamin D in ectopic vascular calcification and discuss the role of screening early intervention and management of established vascular calcification

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