Can young adults develop chronic renal insufficiency?

Can Young Adults Develop Chronic Renal Insufficiency?

Yes, young adults absolutely can and do develop chronic renal insufficiency (CKD), and this population is growing due to improved pediatric survival rates and increasing detection of kidney disease in childhood. 1

Epidemiology and Scope

• Approximately 25% of all teenagers and young adults with CKD present primarily to adult services, usually after age 16, meaning they develop or are first diagnosed with kidney disease during young adulthood 1

• The number of young patients with CKD has progressively increased due to improved management resulting in patient survival rates of 85-90% from pediatric kidney disease 1

• Adult renal services are being exposed to an increasing number of adolescent and young adult patients (ages 14-24 years) who either transitioned from pediatric care or presented directly to adult services 1

Primary Causes in Young Adults

The etiology differs significantly from older adults and depends on age of onset:

Adolescent-Onset CKD

• Glomerular diseases are the most frequent etiology when CKD develops during adolescence 1

Childhood-Onset CKD Continuing into Young Adulthood

• Congenital abnormalities of the kidney and urinary tract (CAKUT) account for approximately 50% of cases, including renal dysplasia and reflux-associated damage 1
• Hereditary conditions account for another 20% of cases 2
• Together, congenital and hereditary diseases represent approximately 70% of young adults with CKD who developed disease in childhood 2

Diagnostic Challenge

• Adult registries report 20-27% of young adults with CKD have "no specific diagnosis," rising to 28-36% when including unspecified glomerulonephritis 2
• This likely represents under-diagnosis of CAKUT by adult nephrologists, who may be less familiar with congenital conditions compared to pediatric nephrologists 1, 2

Clinical Significance and Risk Assessment

What Constitutes Abnormal GFR in Young Adults

• Normal GFR in young adults is approximately 120-130 mL/min/1.73 m², making values significantly below this concerning even if they don't meet traditional CKD stage 3 criteria 3
• A GFR of 85 mL/min/1.73 m² would be considered excellent for a 65-year-old but is unusually low for a 25-year-old and may justify exclusion as a kidney donor 3
• GFR less than 90 mL/min/1.73 m² in a young adult falls below the threshold used for kidney donor acceptance, indicating this is not normal kidney function for this age 3

Long-Term Outcomes

• Among young adults with CKD and systolic BP ≥130 mm Hg, 3% per year develop heart failure, 20% per year have CKD progression, and 2% per year die 4
• Long-term mortality for children, adolescents, and young adults with CKD remains substantially higher than their healthy counterparts despite improvements in care 5

Childhood Risk Factors for Future CKD

Multiple childhood factors predict development of CKD in young adulthood:

Genetic Factors

• Monogenic disorders and risk alleles 6

Perinatal Factors

• Low birth weight and prematurity 6

Childhood Kidney Diseases

• Congenital anomalies, glomerular diseases, and renal cystic ciliopathies 6

Childhood-Onset Chronic Conditions

• Cancer, diabetes, hypertension, dyslipidemia, and obesity 6

Critical Management Considerations

Transition Period Vulnerability

• Substantial risks of non-adherence occur at the time of transfer from pediatric to adult care and among patients aged 14-24 years managed in adult care 1
• The adolescent/young adult years (ages 14-24) represent a period of increased risk-taking, impulsive behavior, and non-adherence issues related to brain development and maturation 1

Unique Physiological Challenges

• CKD-mineral and bone disorder and anemia are particularly challenging given the rapid growth of adolescents 5
• Endocrine imbalances and malnutrition can delay and limit growth during this critical developmental period 5

Blood Pressure Management

• Higher systolic BP is significantly associated with greater risk of cardiovascular events and CKD progression in young adults with CKD 4
• Baseline systolic BP ≥130 mm Hg (versus <120 mm Hg) shows hazard ratio of 2.13 for cardiovascular events/death and 1.68 for CKD progression 4

Common Pitfalls to Avoid

• Do not assume normal kidney function based on creatinine values that would be acceptable in older adults - young adults should have higher baseline GFR 3
• Do not overlook CAKUT as a diagnosis in young adults - adult nephrologists frequently miss this diagnosis, contributing to high rates of "unspecified" kidney disease 2
• Do not rely on single GFR measurements - confirmation over 3 months is required for CKD diagnosis 3
• Do not neglect to screen for proteinuria - persistent proteinuria is the principal marker of kidney damage 3