Kidney Diseases in Children

What are Kidney Diseases?

Kidney disease in children can range from mild, treatable conditions to serious and life-threatening disorders.

What are the symptoms of Kidney diseases in Children?

The common symptoms seen in children suffering from kidney diseases include:

  1. Swelling of the body (edema)

  2. Blood in the urine (hematuria)

  3. Passing of less amount of urine (oliguria)

  4. Complete stoppage of urine passing (anuria)

  5. Painful urination (dysuria)

  6. Pain in flanks

  7. Elevated blood pressure (hypertension)

  8. Low blood oxygen levels (anemia)

  9. Mass in the abdomen

  10. Failure to thrive

  11. Stunted growth

In case of infections of the kidney and urinary systems, the child may also have a fever. Sometimes, children suffering from serious kidney diseases and kidney failure may have a generalized illness or non-specific findings. Presentations of kidney diseases in children are varied.

It has been observed that some kidney diseases are common in children belonging to certain age groups. The knowledge of their common presentations helps in early identification of kidney diseases in children. Some kidney diseases are common in children belonging to certain age groups

Neonatal period: from birth to 4 weeks of birth

During this period, congenital kidney diseases (that is, disorders that arise from birth) are commonly seen. Sometimes, these disorders may be detected even before the birth of the child, by ultrasound examination of the pregnant mother. After birth, if the neonate is not able to pass urine as a steady stream and instead passes urine as a dribble, some kidney disease should be suspected.

Infancy: Up to 1 year of life

During the first year of life, the child may suffer from a urinary tract infection (UTI). A child suffering from UTI may have symptoms like fever, poor weight gain, excessive crying, vomiting and diarrhoea.

In this age group, certain kidney disorders may cause swelling in the abdomen; these include:

  • Hydronephrosis (accumulation of water and swelling of the kidney)

  • Polycystic Kidney disease (presence of multiple, small and large swellings in the kidney)

  • Wilm’s tumor ( a type of cancer in the kidney)

2-3 years of life

Nephrotic syndrome is a disease of the kidney wherein there is a massive loss of proteins in urine (normally, proteins are preserved by the kidneys). The massive loss of proteins in urine is usually accompanied by the retention of water and salt by the body. This cause edema (swelling, due to collection of water in cavities and tissues in the body). About 20% of cases of nephritic syndrome have onset between 2-3 years of life.

Congenital kidney diseases are common during the first month of life. Up to 1 year of age, the most common kidney diseases usually an infection of the urinary tract. Nephrotic syndrome is usually seen after 2 years of life.

3-6 years of life

Nephrotic syndrome has many causes and variants; the type that is most common in children is known as “Minimal Change Disease”. This condition is most often seen during 3-6 years of life.

A type of kidney infection known as “Post streptococcal glomerulonephritis (PSGN) is also commonly seen in this age group. It usually affects boys, who have had a throat infection or skin infection a few weeks earlier. The child will have puffiness around the eyes and swelling of the legs. The urine color changes from straw –yellow (normal) to cola color (abnormal). Generally, there will be oliguria (passing of less amount of urine). Usually, blood pressure is also elevated. This condition requires immediate evaluation and management in the hospital. Most children having PSGN often recover excellently after appropriate treatment.

Another common condition affecting this group is Rickets. This is usually secondary to dietary deficiency of Vitamin D. Since Vitamin D is required for normal growth of bones, children suffering from Rickets will have weak bones, and present with symptoms such as bowed legs or knock knees, soft skull, disturbed growth, increased fracture tendency, bone pain, muscle weakness and dental problems.

6-14 years of life

Kidney disorders commonly affecting children belonging to this age group include PSGN, nephritic syndrome of types other than minimal change disease and chronic kidney failure.

Between 3-6 years of life, the spectrums of kidney diseases in children usually include minimal change type of nephritic syndrome, post-streptococcal glomerulonephritis and rickets. Chronic kidney disease may be seen in children aged above 6 years.

Kidney Failure in Children

Kidney failure happens when the kidneys slow down or stop properly filtering wastes from the body. This leads to an accumulation of waste products and toxic substances in the blood. If the kidney failure is sudden, it is called as acute kidney injury (AKI); if it is slow, gradual and progressing over time, it is called as chronic kidney disease (CKD).

AKI develops suddenly and usually lasts for a short time. Depending on various factors such as the cause of AKI and the time duration of the treatment, AKI can either disappear completely or can persist and develop into serious disorder having long-lasting consequences and causing life-long problems.

CKD, on the other hand, develops insidiously, and it usually doesn’t disappear with treatment. CKD usually worsens over time, and most often results in kidney failure; a condition medically termed as an end-stage renal disease (ESRD). CKD usually requires dialysis (artificial blood filtering treatment) for life or kidney transplantation. Based on the functioning of the kidney (which is known from an investigation known as eGFR), CKD is divided into 5 stages; stage 1 is the mildest form and stage 5 is ESRD.

Chronic Kidney Disease usually results in kidney failure and requires dialysis for life or renal transplantation surgery

Causes of CKD in children

The important causes of CKD in children may include:

  • Birth defects: for eg;- children born with only one kidney or kidneys with abnormal structures

  • Inherited diseases of the kidney: for Eg: Polycystic Kidney Disease; characterized by the growth of numerous cysts in kidneys

  • Infection

  • Nephrotic  syndrome

  • Systemic diseases involving many organs of the body: for Eg: Lupus

  • Urine blockage or reflux: due to problems of the urinary tract and bladder

CKD in children can result from a variety of conditions such as birth defects, inherited defects of Kidney, infection, nephrotic syndrome, systemic diseases or blockages to urine flow.

Prevention of CKD in children

The most important first step to prevent CKD in children is its early detection

There are three strategies for prevention of CKD in children:

  1. Primary prevention:

This aims to reduce or eliminate the exposure of children to various known factors which can cause CKD. These include:

  • To reduce exposure to infections during infections, during pregnancy, especially toxoplasmosis ( an infection caused by a parasite called Toxoplasma Gondii. The infection is most commonly acquired from contact with cats and their faeces or with raw or uncooked meat0, congenital rubella ( a virus infection acquired from the mother during pregnancy) and cytomegalovirus.

  • To reduce exposure to drugs during pregnancy such as ACE inhibitors/angiotensin receptor blockers (used for the treatment of hypertension) and NSAIDs (pain Killers).

  • To screen for inheritable kidney disease by appropriate genetic counselling

  • Prevention of obesity and lipid abnormalities in children by promoting healthy dietary practices

  • Early detection and appropriate management of hypertension and diabetes in children

  • Screening of children who are at a high risk of developing CKD, as outlined previously

  1. Secondary Prevention:

This aims to prevent the progression of CKD from stage 1 to further stages. This is carried out by prompt treatment and other appropriate measures aimed at halting the progression of CKD. Appropriate adherence to treatment must be ensured by doctors and caregivers.

  1. Tertiary Prevention:

These steps focus on delaying or reducing long term complications, disabilities or impairments in later stages of established CKD, and by doing so, reduce the need for renal transplantation or dialysis.

Prevention strategies of CKD in children include primary prevention, secondary prevention and tertiary prevention.

Kidney diseases in children can result in an emotional, psychological, physical and financial burden to the child and its family. If left untreated, any kidney disease can end up as Chronic Kidney Disease. It is best if we can prevent it at various stages of its progression. Dialysis or renal transplantation in children has better outcomes than in adults, but it can be distressing to the child. As it is always said for all diseases, prevention is better than cure!!

 

Dr Sushanth Kumar

MD, DNB (Nephro)

Consultant Nephrology

KMC Hospital, Dr B R Ambedkar Circle, Mangaluru

 

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