Abstract：
BACKGROUND: The circumstances surrounding chronic kidney disease and its impact on families can be complex and difficult to navigate, leading to these cases being labeled \"challenging.\"
METHODS: We present the case of an adolescent with kidney failure due to unremitting systemic illness and multiple complications ultimately resulting in the family\'s request to forgo dialysis. Medical team members wrestled with meeting the family\'s needs among internal and external constraints.
CONCLUSIONS: Past experiences, systemic inequities, differing perspectives, and consequential decision-making within individual belief systems can lead to friction between and among medical team members and families. As pediatric nephrologists, we must shift our focus from the \"challenging\" patient or family to addressing what is challenging their ability to flourishing.
METHODS: We present the case of an adolescent with kidney failure due to unremitting systemic illness and multiple complications ultimately resulting in the family\'s request to forgo dialysis. Medical team members wrestled with meeting the family\'s needs among internal and external constraints.
CONCLUSIONS: Past experiences, systemic inequities, differing perspectives, and consequential decision-making within individual belief systems can lead to friction between and among medical team members and families. As pediatric nephrologists, we must shift our focus from the \"challenging\" patient or family to addressing what is challenging their ability to flourishing.
摘要：
背景：围绕慢性肾脏疾病及其对家庭的影响的情况可能是复杂且难以驾驭的，导致这些案件被贴上“具有挑战性”的标签。
方法：我们介绍了一例青少年因持续的全身性疾病和多种并发症而导致肾衰竭的病例，最终导致家人要求放弃透析。医疗团队成员在内部和外部约束中努力满足家庭的需求。
结论：过去的经历，系统性不平等，不同的观点，个人信念系统中的相应决策可能导致医疗团队成员和家庭之间的摩擦。作为儿科肾病专家，我们必须把我们的重点从“具有挑战性的”病人或家庭，以解决什么是挑战他们的能力，以繁荣。
方法：我们介绍了一例青少年因持续的全身性疾病和多种并发症而导致肾衰竭的病例，最终导致家人要求放弃透析。医疗团队成员在内部和外部约束中努力满足家庭的需求。
结论：过去的经历，系统性不平等，不同的观点，个人信念系统中的相应决策可能导致医疗团队成员和家庭之间的摩擦。作为儿科肾病专家，我们必须把我们的重点从“具有挑战性的”病人或家庭，以解决什么是挑战他们的能力，以繁荣。
