Adults who had kidney disease in childhood

A young adult male who recently turned 21 years of age has been followed by a group of pediatric kidney specialists since birth as he was born with a single dysplastic kidney. He progressed towards end stage renal disease and started hemodialysis in a pediatric inpatient center at the age of 19 years. Owing to being significantly overweight, he is not a suitable renal transplant candidate. He lives at home with his mother, who is his primary caregiver and his brother. He dropped out of school before the age of 18 years and has currently no intention to finish high school. He has short stature as he refused daily growth hormone injections in the past. During healthcare visits he has always been passive and his mother is making decisions for him. During the last several visits, he and the mother have requested initiation of transition into adult care as he feels it is now time. Both patient and mother also start to ask questions about the adult implications of his chronic kidney disease (CKD). CKD in children is somewhat complex and the implications for adults living with advanced kidney disease since childhood are significant. Optimal care of the adult patient who has been affected by advanced kidney disease since childhood requires a solid understanding of three main domains with significant overlap: (i) the underlying type of kidney disease and the multiple effects that CKD has on the body and mind of a child, (ii) the process of care transitioning from the pediatric to the adult environment, and (iii) the physical and psychosocial effects of the disease on the adult patient.