Understanding kidney disease in children

WHEN it comes to kidney disorders, there is a general misconception of attaching the condition to older persons but this is not quite right, experts say as little children also have kidney challenges. Nephrologists explain Chronic Kidney Disease (CKD) as the slow loss of kidney function over time and the final stages of this disease is referred to as end-stage renal disease (ESRD).

Based on statistics, children and adolescents with end-stage renal disease (ESRD) in sub-Saharan Africa may have the worst outcomes globally. Barriers to management include late presentation, poor socioeconomic conditions, absence of medical insurance, limited diagnostic facilities and non-availability of chronic renal replacement therapy (RRT).

According to experts, pediatric kidney disease is any type of kidney disease that develops in children under the age of 19.

Kidneys in children as well as adults are important because they remove the extra fluids and waste from the body and help regulate blood pressure, ensure chemical balance and maintain the health of the bones.

The rates of CKD are substantially lower in children than adults, but the incidence of CKD is increasing steadily with poor and ethnic minority children disproportionally affected, experts say.

In 2014, a study to determine the incidence, aetiology, management and outcomes of paediatric ESRD in a tertiary hospital in Nigeria, was carried out by a team of paediatric nephrologists in the University College Hospital (UCH), Ibadan. Based on the findings of the study, the team of paediatric nephrologists concluded that the incidence of paediatric ESRD in Ibadan is higher than previous reports from sub-Saharan Africa.

They also discovered that the most common causes were glomerulonephritis and Congenital Anomalies of the Kidneys and Urinary Tract (CAKUT). Dr Adanze Adasinodi, a paediatric nephrologist at the University College Hospital, Ibadan, and her research partners,  Dr Ademola Adebowale, Oluwatoyin Ogunkunle and Susan Mott, who worked on the study stated that mortality due to ESRD is high primarily due to lack of resources and recommended that preventive nephrology and chronic RRT programmes would be urgently needed in the study area.

Director of paediatric nephrology at the Johns Hopkins Children’s Center, Barbara Fivus, gave some positive news on chronic kidney disease affecting children recently. “Kidney disease occurs more often than we think, but it is also more treatable than we used to think, especially when caught early.” “Children and adolescents should be monitored carefully because kidney disease that seems to suddenly strike young adults often has its roots in childhood.”

Increasing awareness among the general population is important to not only reduce the complications of those suffering with pediatric CKD, but also could help reduce the future prevalence of the disease, experts emphasise.

Symptoms associated with paediatric kidney disease

Kidney disease often goes undetected in the general population, but children and adolescents are at an even greater risk due to the nature of the causes of the diseases and the ambiguity of the symptoms, experts say. Common symptoms may include:

• Swelling (even mild) of the hands and feet and/or puffiness around the eyes caused by excess fluid build-up, to the point where the child’s ability to move around normally is compromised
• After initial swelling, socks or a belt can leave an indentation in the skin that will persist.
• Lack of or decrease in appetite.
• Decreased or increased frequency of urination.
• Long-lasting changes in the color of the urine such as unusually dark or red, which can indicate blood, and changes in appearance of urine such as extra foam that can indicate protein
• Headaches resulting from high blood pressure
• Flu-like Symptoms such as nausea, vomiting, weakness, fatigue, loss of appetite
• Stunted or poor growth as compared to similar age group peers
• Difficulty concentrating and poor school performance
• Genetics, a family history of kidney disease.

Causes

According to experts, kidney failure can be caused by many underlying issues and generally falls into two categories of disease, classified as acute or chronic.  Acute diseases generally develop quickly, lasts for a limited amount of time and are more immediately severe than chronic conditions (think food poisoning). However, acute disease can also develop or cause lingering problems.

However, chronic diseases generally develop and worsen over time and do not go away. In children congenital defects causing urinary tract blockages (posterior urethral valves) or small or non-functioning kidneys (hypoplastic and dysplastic) or another disorder that causes scarring of the glomeruli that leads to nephrotic syndrome are the most common causes of kidney diseases.

Until age 4, birth defects and hereditary diseases are by far the leading causes of kidney failure. Between ages 5 and 14, hereditary diseases continue to be the most common causes, but glomerular disease incidence rises.  As children age past 15, glomerular diseases are the leading cause, and hereditary diseases become rarer, nephrologists say.

Treatment Options

According to paediatric nephrologists, children with kidney failure have a few options to choose from, depending on the severity of their disease.  “The primary goal is to have a successful transplant, however viable kidneys are not always available and some children are not strong candidates for transplants,” experts say.

In some cases, a nephrectomy is a solution that can make childhood disease easier to manage.

In most cases parents choose home dialysis options either home hemodialysis, experts say. Dialysis is a treatment used to clean the blood and remove waste when the kidneys are no longer able to do so. Other treatment options include;

Transplants

Half of the kidney transplants in children come from a living donor, usually a parent or other close family member.

• Living Donor Kidney – A kidney from a living donor often has advantages over a kidney from a recently deceased individual.
• A kidney from a parent is guaranteed to match on at least three of six proteins, which means it is less likely to be rejected.
• With a living donation, there is additional time to pre plan and schedule the operation.
• Psychological benefits of knowing that the donation came from a caring family member.
• Live kidneys are more likely to be in good condition, because they do not need to be transplanted.

Children with Chronic Kidney Disease: Tips for Parents

Learn about the disease and its treatments

1. Learn as much about your child’s disease and its treatment as you possibly can.
2. Encourage your child to ask questions not only of you but of doctors, nurses and other health professionals.
3. Don’t try to explain more than your child can understand, but don’t lie and don’t apologize for any treatments or procedures that have to be followed.
4. Help your child understand that the doctors, nurses, social workers, dietitians, laboratory personnel and everyone else is on his or her side.