The continued care of children with renal disease into adult life

Today in developed countries the majority of paediatric patients in hospital units suffer from conditions which will continue into adult life, and paediatric nephrology is no exception to this. Despite its obvious importance, the problem of the transition of these children with continuing renal diseases from paediatric to adult clinics is little discussed and often timed and managed badly, with failures on the part of both paediatricians and internists. However, a number of simple principles and actions can help to make the transition more successful and avoid medical and psychological harm. Nephrology can learn from the similar experience in other areas of paediatrics and medicine, such as diabetes, congenital heart disease and cystic fibrosis. Access to facilities for adolescent medicine remains limited and needs to be expanded. Whilst the management of those clearly needing continued care remains paramount, in addition guidelines for the follow-up management of apparently well young adults following attacks of conditions such as Henoch-Schonlein purpura, the haemolytic-uraemic syndrome and acute renal failure are needed.