Abstract
With the rise in the incidence of childhood obesity, it is increasingly evident that the burden of chronic kidney disease (CKD) has increased proportionately and has its origins in early life. This chapter will discuss the central role of the kidney in the mediation of elements of the metabolic syndrome (MetS) including glucose disposal, hyperinsulinemia, uric acid excretion, and the renin-angiotensin-aldosterone system (RAAS). There is evidence that an adverse fetal environment with accelerated postnatal growth may contribute to a low nephron “endowment” and predispose to MetS and CKD in later life. The focus will be on the primary end points of hypertension, proteinuria, hyperuricemia, urolithiasis, and CKD. We will provide recommended treatment strategies and discuss necessary future research projects related to the MetS and CKD in children and adolescents.