Pediatric Kidney Disease

Kidney disease (renal failure) is short-term or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types:

• Acute kidney disease. Acute kidney disease starts suddenly. In some cases, it may be reversed and the kidneys can work normally again.
• Chronic kidney disease. This type gets worse slowly over at least three months. It can lead to permanent kidney failure.

Acute kidney disease may be caused by:

• Less blood flow to the kidneys for a period of time, such as from blood loss, surgery or shock
• A blockage in the urinary tract
• Taking medicines that may cause kidney problems
• Any condition that may slow or block oxygen and blood to the kidneys, such as cardiac arrest
• Hemolytic uremic syndrome. This is usually caused by an E. coli infection. Kidney failure develops because small structures and vessels in the kidney are blocked.
• Glomerulonephritis. This is a type of kidney disease that happens in parts of the kidneys called glomeruli. The glomeruli become inflamed and harm how the kidney filters urine.

Chronic kidney disease may be caused by:

• A long-term blockage in the urinary tract
• Alport syndrome. This is an inherited disorder. It causes deafness, kidney damage that gets worse over time, and eye defects.
• Nephrotic syndrome. This is a condition that causes protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling.
• Polycystic kidney disease. This is a genetic disorder. It causes many cysts filled with fluid to grow in the kidneys.
• Cystinosis. This is an inherited disorder. The amino acid cystine collects in cells in the kidney called lysosomes.
• Other chronic conditions. Conditions such as diabetes or high blood pressure can lead to kidney problems. If these aren't treated, less oxygen and blood can get to the kidneys.
• Untreated acute kidney disease. Acute kidney disease may turn into chronic kidney disease if not treated.

A child is more at risk for acute kidney disease if he or she has:

• Blood loss, surgery or shock
• A blockage in the urinary tract
• Been taking medicines that may cause kidney problems
• A condition that may slow or block oxygen and blood to the kidneys, such as cardiac arrest
• Hemolytic uremic syndrome
• Glomerulonephritis

A child is more at risk for chronic kidney disease if he or she has:

• A long-term blockage in the urinary tract
• Alport syndrome
• Nephrotic syndrome
• Polycystic kidney disease
• Cystinosis
• Untreated diabetes
• Untreated high blood pressure
• Untreated acute kidney disease

The symptoms for acute and chronic kidney disease may be different. These are the most common symptoms. But symptoms may be a bit different for each child.

Symptoms of acute kidney disease can include:

• Bleeding (hemorrhage)
• Fever
• Rash
• Bloody diarrhea
• Severe vomiting
• Stomach pain
• No urine or lots of urine
• Pale skin
• Swelling of the tissues
• Inflammation of the eye
• Stomach mass

Symptoms of chronic kidney disease can include:

• Poor appetite
• Vomiting
• Bone pain
• Headache
• Stunted growth
• Malaise
• Lots of urine or no urine
• Repeated urinary tract infections
• Urinary incontinence
• Pale skin
• Bad breath
• Hearing problems
• Stomach mass
• Tissue swelling
• Irritability
• Poor muscle tone
• Change in mental alertness

The symptoms of acute and chronic kidney disease can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Your child's healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:

• Blood tests. These look at blood cell counts, electrolyte levels and kidney function.
• Urine test. This test looks for protein and blood in the urine and other problems.
• Renal ultrasound (sonography). This is a painless test that uses sound waves and a computer to create images of body tissues. During the test, your child's healthcare provider moves a device called a transducer over the belly in the kidney area. This sends a picture of the kidney to a video screen. Your healthcare provider can see the size and shape of the kidney. He or she can also see a growth, kidney stone, cyst or other problems.
• Renal biopsy. The healthcare provider takes a small sample of kidney tissue. This is done through the skin with a needle or during surgery. The sample is looked at under a microscope.

Most children with kidney disease see both a pediatrician or family healthcare provider and a nephrologist. A nephrologist is a healthcare provider with special training to treat kidney problems.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is. It also depends what kind of kidney disease your child has.

Treatment of acute kidney disease depends on what is causing it. Treatment may include:

• A hospital stay
• IV (intravenous) fluids in large amounts to replace fluid loss
• Medicines called diuretics to increase the amount of urine made
• Close watching of blood salts (electrolytes) such as potassium, sodium and calcium
• Medicines to control blood pressure
• Changes to diet (see below)

Treatment of chronic kidney disease depends on how well the kidney is still working. Treatment may include:

• Medicines to help with growth, prevent loss of bone density, treat anemia, or a combination of these
• Medicines called diuretics to increase the amount of urine made
• Changes to diet (see below)
• Dialysis (see below)
• Surgery to remove a damaged kidney and replace it with a healthy one (kidney transplant)

Your child may need to make changes to his or her diet. Your child may need to limit:

• Protein. Protein is vital for proper growth and nutrition. But the kidneys may not be able to get rid of the waste products that come from eating too much protein. Your child's healthcare provider will talk with you about how much protein your child needs.
• Potassium. Potassium is an important nutrient. But when the kidneys don’t work well, too much potassium can build up in the blood. Potassium comes from certain foods. Your child may need to limit or not eat foods with a lot of potassium.
• Phosphorus. The kidneys help remove extra phosphorus from the body. If the kidneys are not working well, too much phosphorus builds up in the bloodstream and can cause calcium to leave the bones. This can make your child's bones weak and easy to break. Your child may need to limit foods with phosphorus.
• Sodium. A low-sodium diet can help prevent or reduce fluid retention in your child's body. Your healthcare provider will talk with you about the amount of sodium allowed in your child's diet.

In some cases, a child may develop severe problems with electrolytes. This may cause dangerous levels of waste products in the blood that are normally removed by the kidneys. A child may also develop fluid overload. A child may need dialysis in these cases.

Dialysis is a procedure that filters waste and extra fluid from the blood. This is normally done by the kidneys. There are two types of dialysis.

Peritoneal Dialysis

This can be done at home. This method uses the lining of the belly (abdominal) cavity to filter the blood. This cavity is the space that holds organs such as the stomach, intestines and liver. The lining is called the peritoneum.

First, a surgeon places a thin, flexible tube (catheter) into your child’s belly. After the tube is placed, a sterile cleansing fluid (dialysate) is put through the catheter into the peritoneal cavity. The fluid is left in the belly for a period of time. This fluid absorbs the waste products through the peritoneum. The fluid is then drained from the belly, measured, and discarded. This process of filling and draining fluid is called an exchange.

Hemodialysis

This is done in a dialysis center or hospital by healthcare providers. A special type of access, called an arteriovenous (AV) fistula, is placed during a small surgery. This fistula is an artery and a vein that are joined together. It is usually done in your child's arm. An external IV (intravenous) catheter may also be inserted. This is less common for long-term dialysis.

Your child will then be connected to a large hemodialysis machine. Blood is pumped through a tube into the machine to filter out the wastes and extra fluid. The filtered blood then flows through another tube back into your child's body. Hemodialysis is usually done several times a week. Each session lasts for four to five hours. It may be helpful to bring games or reading materials for your child to keep him or her stay busy during this procedure.

Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all treatments.

Because the kidneys have many functions, kidney failure can affect many body systems. Complications may include:

• Low red blood cell count (anemia)
• Problems with the heart and blood vessels
• Bone disease
• Pain in the bones, joints and muscles
• Decreased mental function, including confusion and dementia
• Nerve damage in the arms and legs
• A greater risk of getting infections
• Poor nutrition
• Skin changes, including dryness and itching

Call your child’s healthcare provider if your child has:

• Symptoms that don’t get better or get worse
• New symptoms