Undiagnosed Chronic Kidney Disease in a Child With Fractures Presenting to a Pediatric Orthopedic Clinic.

Pediatric fractures that present without identified trauma can present a challenge to the nurse practitioner in the orthopedic clinic. Etiologies range from nonaccidental trauma to genetic and metabolic diagnoses that may have been previously undetected. It is imperative that the orthopedic nurse practitioner exercise critical thinking to recognize the potential for underlying diagnoses that can contribute to a child's injuries and make the appropriate referrals in a timely manner. This case study describes a child who presented to a pediatric orthopedic clinic with fractures in various stages of healing without known trauma, and through diligent investigation, was found to have previously undiagnosed chronic kidney disease.