Kidney disease in children occurs when damage to the kidneys results in their inability to properly filter waste products and excess fluid out of the blood. This damage can have several different causes, and it may be sudden and temporary (acute) or long-lasting (chronic).
While kidney disease in children is not very common, kidney conditions can be especially disruptive and emotionally challenging for affected children. The leading causes of kidney disease in children include:
Kidney trauma or injury
Problems with the urinary system, according to the American Kidney Fund
Identifying symptoms of kidney disease can be particularly challenging in children, so it’s important to report any potentially concerning health changes to your child’s doctor. Treatment for kidney disorders in children will be based on the specific condition and may last for a short or long duration. If your child’s kidney disease progresses to kidney failure, regular dialysis treatments or a kidney transplant will be needed.
SIGNS AND SYMPTOMS OF KIDNEY DISEASE IN CHILDREN
Since there are many potential causes of kidney disease in children, signs and symptoms of kidney problems can be varied and nonspecific (meaning the symptoms potentially indicate many different health conditions).
The early stages of kidney disease in children often cause few to no symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). But as the kidney problems worsen, the symptoms often include:
Swelling (edema) in the legs, feet, hands, or face
Increased or decreased urination (including wetting the bed)
Foamy or frothy urine (caused by protein in urine)
Pink or dark-colored urine (caused by blood in urine)
Other, less specific signs and symptoms that may indicate kidney disease in children include:
Fatigue or weakness
High blood pressure
Shortness of breath
Nausea or vomiting
If your child develops acute (sudden-onset) kidney disease, the following symptoms may occur, according to the University of Rochester Medical Center:
Not urinating, or urinating in excess
Swelling throughout the body
Swollen eye or eyes
If your child develops any of these severe symptoms, contact your healthcare provider right away — or seek urgent medical attention.
Causes and Risk Factors of Kidney Disease in Children
Kidney disease in children can be caused by a range of conditions, which are typically distinct from the causes of kidney disease in adults. Kidney disease in children may be acute (occurring suddenly) or chronic (developing gradually and long-lasting).
The causes of acute kidney disease in children include the following, according to the University of Rochester Medical Center:
Reduced blood flow to the kidneys
Blockage in the urinary tract
Hemolytic uremic syndrome
Reduced blood flow to the kidneys may be caused by surgery, blood loss, dehydration, or cardiac arrest, among other health conditions.
Hemolytic urinary syndrome is a rare condition that is typically caused by an infection with E. coli bacteria, and it occurs when the small blood vessels in the kidneys get damaged or inflamed.
Glomerulonephritis is inflammation of the tiny filters in the kidneys (known as glomeruli). It can be caused by several different health conditions, but sometimes the cause is unknown, according to the Mayo Clinic.
Causes of chronic kidney disease in children include:
Lasting blockage in the urinary tract
Alport syndrome (an inherited genetic disorder)
Cystinosis (an inherited genetic disorder)
Polycystic kidney disease (an inherited genetic disorder)
Untreated acute kidney disease
Alport syndrome typically involves a range of health problems, including hearing and eye damage, as well as kidney disease that gets worse over time.
Cystinosis involves the amino acid cystine collecting in cells in the kidneys, causing damage over time.
Nephrotic syndrome is a group of symptoms involving protein in the urine, high cholesterol and tissue swelling. In children, it’s often caused by extremely microscopic damage to blood vessels in the kidneys, known as minimal change disease, according to the American Kidney Fund.
Polycystic kidney disease involves the growth of small fluid-filled sacs in the kidneys, which can cause damage and displace healthy kidney tissue over time.
Other potential causes of chronic kidney disease in children include chronic health conditions like diabetes, high blood pressure, lupus, and chronic urinary tract infections.
Chronic kidney disease is more common in boys than girls. In North America, it’s also 2 to 3 times more common in Black children than in white children, according to NIDDK.
Stages of Chronic Kidney Disease
In children and adults with chronic kidney disease, the kidneys are less efficient at filtering waste products and excess fluid from your blood. This means that the kidneys don’t remove all the waste and extra fluid that they should.
Depending on how well the kidneys are able to filter blood, chronic kidney disease in adults and children ages 2 and older is divided into five different stages — from mild disease to kidney failure. Each stage is defined by your glomerular filtration rate (GFR), a measure of kidney function, the American Kidney Fund notes.
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Here are the five stages of chronic kidney disease:
Stage 1 You have mild kidney damage, with a normal GFR.
Stage 2 You have more kidney damage, with a mild decrease in GFR.
Stage 3 You have substantial kidney damage and a moderately decreased GFR.
Stage 4 You have severe kidney damage and a sharply decreased GFR.
Stage 5 You have kidney failure, with a very low GFR.
For adults and children ages 2 and older, the GFR for each stage of CKD is 90 or higher (stage 1), 60 to 89 (stage 2), 30 to 59 (stage 3), 15 to 29 (stage 4), and below 15 (stage 5).
For infants and very young children, the above numbers do not apply — for example, a healthy newborn typically has a GFR between 40 and 60. In this age group, urine or imaging tests — rather than GFR — are used to evaluate chronic kidney disease.
How Is Kidney Disease Diagnosed in Children?
Your doctor will use your child’s symptoms and health history, family history, a physical exam, and certain urine, blood, or imaging tests to diagnose kidney disease, according to NIDDK.
Blood and Urine Tests
Commonly used tests to diagnose kidney disease include the following, according to the Cleveland Clinic:
Glomerular Filtration Rate This blood test estimates how efficiently your child’s kidneys are filtering blood.
Serum Creatinine This blood test measures creatinine, a waste product that is normally excreted in urine. A high level in your child’s blood means that their kidneys aren’t filtering it out well enough.
Urine Albumin Test This test looks at how much protein and blood are in your child’s urine, which can indicate kidney damage.
If blood and urine tests show that your child may have kidney disease, your doctor may order any of the following imaging tests to look at the structure and size of your child’s kidneys, as well as their urinary tract:
A kidney biopsy may be used to check for kidney damage when imaging tests are unclear, or to help identify the causes of kidney disease. It involves taking a small sample of kidney tissue by numbing the area and inserting a long, thin needle through the skin into one of the kidneys. The tissue sample will be sent to a lab for analysis.
Genetic testing may be used to identify inherited disorders that can cause kidney disease.
Treatment and Management of Kidney Disease in Children
Treating kidney disease in children begins with identifying and then treating any underlying conditions that are causing or contributing to kidney damage, the NIDDK notes. For example, antibiotics may be used to treat a kidney infection, and surgery may be needed to resolve a blockage in your child’s urinary tract.
If an underlying condition has led to acute (sudden-onset) kidney disease, your child may need to be hospitalized to help treat the condition and promote kidney function. If your child develops acute kidney failure, dialysis (artificial filtration of the blood to remove waste products and excess fluid) may be needed for a period of time until kidney function is restored.
If your child has chronic kidney disease, medications and dietary changes may help reduce ongoing kidney damage. Chronic kidney disease may also raise your child’s risk of infections, so it’s important to stay up to date on vaccinations — including some that may only be recommended in certain high-risk situations.
The following medications may be used to help treat chronic kidney disease in children, according to NIDDK:
Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers These drugs help lower blood pressure and reduce protein loss in urine.
Diuretics These drugs help reduce swelling and lower blood pressure by removing excess fluid from the body.
Corticosteroids These and other immune-suppressing drugs may be used to help reduce swelling.
Phosphate Binders These drugs reduce blood phosphorus levels and can help improve bone development.
Sodium Bicarbonate This and other pH-adjusting medications may be used to help lower acid levels in the blood.
Your child’s doctor may also prescribe medications to help with specific complications of chronic kidney disease, such as growth hormones to promote growth or erythropoiesis-stimulating agents to treat anemia (inadequate red blood cells).
Managing what your child with chronic kidney disease eats can be complicated, since certain nutrients are vital to growth and well-being — yet others can cause problems when they build up in the blood.
Your doctor may advise limiting (but not eliminating) the following nutrients in your child’s diet, according to the University of Rochester Medical Center:
Protein While getting enough protein is important, too much protein in your child’s diet can contribute to the buildup of waste products.
Phosphorus If phosphorus builds up in your child’s blood, their bones can lose calcium and become weak and brittle.
Potassium Getting enough potassium is important, but too much can build up in the blood in children with chronic kidney disease.
Sodium Reducing sodium in your child’s diet can help reduce extra fluid being retained in the body.
If your child develops kidney failure, either a kidney transplant or dialysis will be needed. Dialysis involves filtering waste products and excess fluid from the blood when the kidneys can no longer do so.
There are two main types of dialysis, according to the University of Rochester Medical Center:
Hemodialysis This type of dialysis typically takes place at a dialysis center or hospital. Your child’s blood is sent through a hemodialysis machine and returned to their body. Typically, each session lasts about 3 to 4 hours and happens three times a week, according to NIDDK.
Peritoneal Dialysis This process can be done at home, and it involves filling your child’s abdominal cavity with a fluid (dialysate) that draws extra waste products and fluid from the blood. First, a surgeon must place a tube (catheter) in your child’s abdomen.
If your child has chronic kidney disease, dialysis will need to continue indefinitely, unless your child is a candidate for a kidney transplant.
Kidney transplants are commonly used to treat chronic kidney disease in children, according to NIDDK. About one-third of these transplants involve kidneys from living donors, often from a parent. Your child may be able to receive a kidney transplant before starting on dialysis, known as a preemptive transplant.
COMPLICATIONS OF KIDNEY DISEASE IN CHILDREN
Kidney disease can lead to a number of potential complications in children, including slowed growth and development. The best way to prevent complications is to treat and manage your child’s kidney disease to the best of your ability, according to the American Kidney Fund.
Common complications of kidney disease in children include:
Growth Delays In addition to managing your child’s kidney disease, your doctor may recommend certain supplements or growth hormones to help your child grow to be a healthy adult.
Developmental Delays Children with kidney disease may experience difficulty learning, concentrating, and remembering things. This can include having poor body coordination and difficulty learning to walk or talk.
Anemia Your child may develop a low red blood cell count that requires medications or supplements to treat.
Bone Disease Your doctor may recommend medications, growth hormones, or dietary changes to help manage or prevent bone loss or bone weakness.
Emotional and Behavioral Problems Living with kidney disease can be enormously difficult, affecting your child’s behavior, relationships with others, and self-esteem. Talk to your doctor about mental health resources if you believe your child is experiencing emotional difficulties.