Kidney disease can affect children in various ways, ranging from treatable disorders without long-term consequences to life-threatening conditions. Acute kidney disease develops suddenly, lasts a short time, and can be serious with long-lasting consequences or may go away completely once the underlying cause has been treated. Chronic kidney disease (CKD) does not go away with treatment and tends to get worse over time. CKD eventually leads to kidney failure, described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis.
Children with CKD or kidney failure face many challenges, which can include
- A negative self-image
- relationship problems
- behavior problems
- learning problems
- trouble concentrating
- delayed language skills development
- delayed motor skills development
Children with CKD may grow at a slower rate than their peers, and urinary incontinence—the loss of bladder control, which results in the accidental loss of urine—is common.
Causes
Kidney disease in children can be caused by
- birth defects
- hereditary diseases
- infection
- nephrotic syndrome
- systemic diseases
- trauma
- urine blockage or reflux
From birth to age 4, birth defects and hereditary diseases are the leading causes of kidney failure. Between ages 5 and 14, kidney failure is most commonly caused by hereditary diseases, nephrotic syndrome, and systemic diseases. Between ages 15 and 19, diseases that affect the glomeruli are the leading cause of kidney failure, and hereditary diseases become less common.
Symptoms
The signs and symptoms in advanced chronic kidney disease may include the following:
- Volume overload
- Hyperkalemia
- Metabolic acidosis
- Hypertension
- Anemia
- Bone disease (termed osteodystrophy)
- Cardiovascular disease
- Anorexia, nausea, vomiting
Diagnosis
- Dipstick test for albumin
- Urine albumin-to-creatinine ratio
- Blood test
- Imaging studies
- Kidney biopsy
Treatment
Treatment for kidney disease in children depends on the cause of the illness. A child may be referred to a pediatric nephrologist — a doctor who specializes in treating kidney diseases and kidney failure in children — for treatment. Children with a kidney disease that is causing high blood pressure may need to take medications to lower their blood pressure. Improving blood pressure can significantly slow the progression of kidney disease. The health care provider may prescribe
- angiotensin-converting enzyme (ACE) inhibitors, which help relax blood vessels and make it easier for the heart to pump blood
- angiotensin receptor blockers (ARBs), which help relax blood vessels and make it easier for the heart to pump blood
- diuretics, medications that increase urine output
Many children require two or more medications to control their blood pressure; other types of blood pressure medications may also be needed.As kidney function declines, children may need treatment for anemia and growth failure. Anemia is treated with a hormone called erythropoietin, which stimulates the bone marrow to produce red blood cells. Children with growth failure may need to make dietary changes and take food supplements or growth hormone injections. Children with kidney disease that leads to kidney failure must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.
Diet and Nutrition
For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Staying healthy with CKD requires paying close attention to the following elements of a diet:
- Protein: Children with CKD should eat enough protein for growth while limiting high protein intake. Too much protein can put an extra burden on the kidneys and cause kidney function to decline faster. Protein needs increase when a child is on dialysis because the dialysis process removes protein from the child’s blood. The health care team recommends the amount of protein needed for the child. Foods with protein include
- eggs
- milk
- cheese
- chicken
- fish
- red meats
- beans
- yogurt
- cottage cheese
- Sodium: The amount of sodium children need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care team may recommend limiting or adding sodium and salt to the diet. Foods high in sodium include
- canned foods
- some frozen foods
- most processed foods
- some snack foods, such as chips and crackers
- Potassium: Potassium levels need to stay in the normal range for children with CKD, because too little or too much potassium can cause heart and muscle problems. Children may need to stay away from some fruits and vegetables or reduce the number of servings and portion sizes to make sure they do not take in too much potassium. The health care team recommends the amount of potassium a child needs. Low-potassium fruits and vegetables include
- apples
- cranberries
- strawberries
- blueberries
- raspberries
- pineapple
- cabbage
- boiled cauliflower
- mustard greens
- uncooked broccoli
- High-potassium fruits and vegetables include
- oranges
- melons
- apricots
- bananas
- potatoes
- tomatoes
- sweet potatoes
- cooked spinach
- cooked broccoli
- Phosphorus: Children with CKD need to control the level of phosphorus in their blood because too much phosphorus pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus also can cause itchy skin and red eyes. As CKD progresses, a child may need to take a phosphate binder with meals to lower the concentration of phosphorus in the blood. Phosphorus is found in high-protein foods. Foods with low levels of phosphorus include
- liquid nondairy creamer
- green beans
- popcorn
- unprocessed meats from a butcher
- lemon-lime soda
- root beer
- powdered iced tea and lemonade mixes
- rice and corn cereals
- egg white
- sorbet
- Fluids: Early in CKD, a child’s damaged kidneys may produce either too much or too little urine, which can lead to swelling or dehydration. As CKD progresses, children may need to limit fluid intake. The health care provider will tell the child and parents or guardians the goal for fluid intake.