Chronic Kidney Disease In Children

Table of Content

• What is Chronic Kidney Disease (CKD)?

• Causes of Chronic Kidney Disease in Children

• Kidney Disease Paediatric Symptoms

• Risks associated with Chronic Kidney Disease

• Treatment for Kidney Disease in Children

• Take-Home Points

• FAQ on Chronic kidney disease in children

Introduction

Kidneys are the cleaning system in your body. They filter the impurities in your blood and help in maintaining homeostasis. Not only do they remove waste but they also help in a child's growth by regulating the number of micronutrients and hormones. In this article, you would know the incidence of kidney disease in children and the treatments available for treating it. 

What is Chronic Kidney Disease (CKD)?

Chronic kidney disease (CKD) is characterized by poor functioning of the kidneys which includes improper removal of toxins from the blood, low management of hormone levels and poor regulation of micronutrients. CKD renders the kidneys with reduced efficiency and increased irregularities in normal functions. 

Kidney Failure in Children Statistics

Due to the lack of accurate national data, the prevalence of CKD in India is not clear but researchers estimate that the number of new patients diagnosed with End Stage Kidney Disease (ESKD) who take up dialysis or kidney transplantation is over 100,000 per year. Chronic Kidney disease in infants has also increased in exponential proportions in the last decade. 

What are Pediatric CKD Stages?

The severity of Chronic Kidney Disease is primarily determined by glomerular filtration rate (GFR) — a measurement of how effectively the kidneys are filtering blood. According to the National Kidney Foundation, there are five stages of CKD:

Stage 1: Kidney damage with normal or increased GFR (≥90)

Stage 2: Kidney damage with mild decreased GFR (60-89)

Stage 3: Moderate decreased GFR (30-59)

Stage 4: Severe increased GFR (15-29)

Stage 5: Kidney failure GFR (<15)

As the stages progress, it is difficult to treat kidney disease. 

Causes of Chronic Kidney Disease in Children

Chronic Kidney Disease in children can be caused by both congenital and acquired kidney disorders. 

Some of the birth defects or abnormalities in kidneys include 

• Dysplastic kidneys that were formed incorrectly and cannot do their normal function.

• Obstruction of blood flow to kidneys that can cause serious complications.

• Reflux from the bladder backs up into the kidneys which can cause severe infection.

Kidney diseases in children can also occur to acquired neurological abnormalities such as 

• The presence of protein levels in urine.

• Low incidence of protein in the blood (it’s being lost in the urine).

• Swelling in the body, particularly around the ankles and eyes. This happens because the proteins that hold water are lost in the urine and hence facilitate the seeping of water into the body’s tissues

• To compensate for the low presence of protein, the body makes fat in the form of cholesterol, which increases cholesterol levels. 

Kidney Disease Paediatric Symptoms

Symptoms of Kidney disease in children may vary depending upon the stage of CKD. But the most common paediatric symptoms include, 

• Fatigue

• Problems concentrating

• Trouble sleeping, restless leg syndrome

• Generally feeling unwell

• Fever

• Loss of appetite

Risks associated with Chronic Kidney Disease

The common complications associated with CKD include, 

• High blood pressure

• Anaemia (low levels of red blood cells)

• Weak bones

• Malnutrition

• Growth failure

• Nerve damage

To avoid the incidence of these complications, it is important to treat kidney diseases in their early stage.

Treatment for Kidney Disease in Children

Stage 1, 2, 3 and 4 CKD in children, can be supported through medications like erythropoietin, calcium acetate and calcium carbonate. 

But, when your kid reaches the final stage of CKD, the only resorts are kidney transplants and dialysis. 

Dialysis 

Nearly all children with End Stage Kidney Disease (ESKD) need to receive kidney transplants. If a living-related kidney donor couldn't be found, dialysis is the final resort to sustain the patient's life.  

The two forms of dialysis that are majorly done are, 

• Hemodialysis

Here, the blood is filtered outside the body through a dialysis machine. These types of dialysis take several hours and usually need to be done three or more times a week. In most cases, hemodialysis is done in a dialysis centre rather than at home.

• Peritoneal Dialysis

This type uses your body's peritoneal membrane (beneath the outer layers of the abdominal wall) to filter the toxins and impurities from your blood. There are two forms of peritoneal dialysis available –continuous cycling peritoneal dialysis and continuous ambulatory peritoneal dialysis. The former uses a simple machine to perform the dialysis at night while the latter requires no machines and can be done during the day. 

Both types of dialysis require dietary limits regarding fluids, salts and phosphorus. With fewer restrictions, peritoneal dialysis can mean more flexibility, and children would prefer it over other dialysis methods. 

Helping Your Child

If you are having a child that suffers from CKD, it is important to support them both physically and psychologically. Here are some of how you can support your child, 

• Restricting Sodium Foods

Kids with kidney disease need to restrict their intake of sodium, which is found commonly in table salt and many foods. Some other salt preparations (for example Himalayan salts) are just as high in sodium levels as common table salt.

• Encouraging Exercise Routines 

Exercise will help your child sweat and get rid of excess fluid, thereby flushing out the toxins. Exercises like walking and strength training make bones stronger and stimulate muscles and nerves which can help ease restless leg syndrome, a common syndrome associated with many kidney disorders.

• Provide Emotional Support

Beyond these physical concerns, kids should be encouraged and supported to express their feelings. During hemodialysis sessions, encouraging them to do homework, and work on art projects can greatly serve as a positive distraction. 

Take-Home Points

• Chronic Kidney Disease (CKD) is a condition where your kidneys couldn't perform the work of filtering your blood, regulating the micronutrients and maintaining hormone levels. 

• Fatigue, problems concentrating, trouble sleeping, restless leg syndrome, generally feeling unwell, fever and loss of appetite are common symptoms of CKD in children. 

• CKD in children can be caused by kidney birth defects, genetic diseases, kidney infection, nephrotic syndrome, kidney trauma or injury or problems with the urinary system.

FAQ on Chronic kidney disease in children

1. What is the most common cause of chronic kidney disease in children?

Ans. In infants, birth defects and hereditary diseases are the leading causes of kidney failure but in children from ages 5 and 14, kidney failure is most commonly caused by hereditary diseases, nephrotic syndrome, and other systemic diseases.

2. Is chronic kidney disease common in children?

Ans. Yes! For the past two decades, the incidence of Chronic Kidney disease in children has steadily increased.

3. What are the signs of kidney problems in kids?

Ans. Common symptoms of CKD include fever, swelling (around the eyes, face, feet, and ankles), burning or pain during peeing, an increase in the frequency of urination, and difficulty in holding urine. 

4. What can cause kidney disease in a child?

Ans. CKD can be caused by kidney birth defects, genetic diseases, kidney infection, nephrotic syndrome, kidney trauma or injury or problems with the urinary system can cause kidney disease in a child. 

5. What are the 3 early warning signs of kidney disease?

Ans. Experiencing dizziness, fatigue, swelling (edema) or changes in the frequency of urination are the common warning signs of kidney disease. 

6. Can a child recover from kidney failure?

Ans. Yes! Once the cause of the CKD is treated, the kidney heals and returns to normal. 

7. How is kidney function tested in children?

Ans. Medical professionals know the efficiency of your kidneys by analysing the blood and urine samples. 

8. Does chronic kidney disease go away?

Ans. No! There's usually no cure for chronic kidney disease, but proper treatment can relieve the symptoms and stop the progression of the disease. 

9. How can I improve my child's kidney function?

Ans. Give your children enough water for their age as water plays an important role in maintaining kidney health.  

10. What are the diseases that affect the kidney?

Ans. Diseases like Atypical hemolytic uremic syndrome (aHUS), Alport syndrome, Amyloidosis, Goodpasture syndrome, Cystinosis, Fabry disease, Focal segmental glomerulosclerosis (FSGS) and Glomerulonephritis (glomerular disease) affects kidneys and causes failures. 

11. What major complication is associated with a child with chronic renal failure?

Ans. Growth failure or stunted growth is the most common complication associated with chronic renal failure. 

12. What is the first indication of nephrotic syndrome in children?

Ans. Seeing the swell around your child's eyes in the morning is often the first sign of nephrotic syndrome in children. 

13. What is the biggest indicator of kidney disease?

Ans. The glomerular filtration rate is the best indicator of kidney function. It is a better indicator than serum creatinine level as it does not reflect kidney function accurately.

14. What are the symptoms of stage 1 kidney disease?

Ans. Having high blood pressure, swelling in your hands or feet, urinary tract infections, and having protein or blood in your urine indicates the presence of stage 1 kidney disease. 

15. What is the new treatment for chronic kidney disease?

Ans. As of now, FDA has approved Kerendia (finerenone) tablets to reduce the risk of kidney function decline and kidney failure which is new compared to other kidney-related treatments. 

16. Can kids go on dialysis?

Ans. Yes! Some kids with sudden (acute) kidney failure need dialysis for a short time until the kidneys get better and normal.

17. How long can children live on dialysis?

Ans. The survival probability percentage of 1-, 3-, 5- and 8-year-old CKD patients ( who are undergoing dialysis) is 96%, 88%, 84% and 84% respectively.

18. At what age do kidney problems occur?

Ans. Kidney disease can develop at any age, but those over the age of 60 are more vulnerable than other age groups.

References

• Causes and Treatment of CKD in Children

• Chronic Kidney Disease in Children - Types and Epidemiology