Over the past 20 years, the incidence of
chronic kidney disease (CKD) in children has steadily increased.
What is CKD?
CKD is a chronic condition in which the kidneys are permanently damaged. Kidney function is decreased, and it gets worse over time. CKD is also called
chronic renal disease or
chronic kidney failure. It affects people of all ages and races.
What causes CKD?
The causes of CKD are very different in children than in adults.
In infants and children: Birth defects,
congenital abnormalities, and
hereditary diseases, like polycystic kidney disease, are the most common causes of CKD. Frequent
urinary tract infections (UTIs) in children should be promptly treated and further evaluated, as urinary tract abnormalities could potentially lead to CKD.
In teenagers: In children over the age of 12, glomerulonephritis (inflammation of the kidneys) is the most frequent cause of kidney failure. Other conditions that may damage the kidneys, like nephrotic syndrome, or diseases that affect many organs, like lupus, are also common causes.
In adults: CKD is mainly caused by
high blood pressure. In contrast to adults, high blood pressure does not usually cause kidney failure in children, but often is caused by the renal failure. However, it is important to note that
many of the risk factors for CKD, such as obesity leading to type 2 diabetes, start in childhood and may contribute to progressive kidney disease in adulthood.
What are common symptoms of CKD in children?
As CKD progresses, symptoms in children may include:
- Swelling and/or puffiness around the eyes, feet, and ankles
- Frequent urination or, in children 5 years or older, prolonged bedwetting
- Stunted or poor growth, as compared to similar age group peers
- Loss of appetite and chronic nausea
- Frequent severe headaches from high blood pressure
- Anemia and pallor from decreased red blood cell production
How is CKD diagnosed?
CKD is diagnosed many ways. Some kidney problems are found before birth by
ultrasound. Sometimes, children are diagnosed with other conditions where kidney problems are known to be more common. Usually, there are other concerns about a child's health that lead to a diagnosis of CKD.
Based on a child's health issues or symptoms, his or her pediatrician may run the following tests:
Urinalysis: A child's urine will be collected to check for protein.
Protein in the urine may be a sign of kidney damage.
Blood tests: Blood tests can help show many things, including kidney function level, blood chemical levels, and red blood cell levels, all of which the kidneys help to control. Sometimes, there are also specialized blood tests that may help diagnose specific kidney diseases such as lupus.
Ultrasound and X-rays: Pictures of the kidneys help show any damage to the kidney and surrounding structures. They may also give hints about what caused the kidney problem.
Kidney biopsy: A small piece of kidney tissue is taken out and examined under a microscope to determine the cause of and extent of damage to the kidneys.
What kinds of CKD are there?
CKD is staged to show how much kidney function is left. Because kidney function decreases over time, the stage of CKD changes. When a person is first diagnosed, it could be in any of the five stages; not everyone progresses from Stage 1 to Stage 5.
A value called
glomerular filtration rate (GFR) is determined to help to estimate kidney function. Note that GFR values for CKD staging are for children older than 2 years of age, because the GFR values for children under two are low due to ongoing kidney growth.
How is CKD treated?
CKD is considered permanent damage to the kidneys that cannot be cured. However, there have been major improvements in the care of children with CKD that can slow the progression of the disease and can prevent other serious conditions developing.
The main goals of treatment are to:
- Help treat the condition that may be causing CKD
- Control symptoms of CKD
- Slow down progression of CKD with proper diet and medications
- Prepare for eventual kidney failure (Stage 5) and the need for dialysis and/or kidney transplant
Who is involved in the medical care for a child with CKD?
The child's pediatrician will continue to oversee routine healthcare, including
immunizations. The pediatrician will work with the
pediatric nephrologist who will assist in the child's health care management including diet and medications. Other
pediatric specialists, such as a pediatric urologist, may be included in the child's care based on the child's health care needs and on his or her own characteristics.
Parents and other caretakers at home provide the cornerstone of their child's care, as they provide emotional support and help their child follow the proper diet and take all prescribed medications.