If someone has chronic kidney disease (CKD), it means their kidneys are damaged and aren't filtering blood effectively. The condition affects people of all ages and backgrounds, including children.
What are common causes of CKD in kids?
Infants and children
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Birth defects like
posterior urethral valves and
diseases found in families, such as polycystic kidney disease, are the most common causes of CKD in children.
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Urinary tract abnormalities could potentially lead to CKD. For this reason, frequent
urinary tract infections (UTIs) in children should be promptly treated and further evaluated.
Teenagers
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Focal segmental glomerulosclerosis
(FSGS). In children over 12 years old,
FSGS is one of the most common causes of CKD.
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Lupus. Another common cause of CKD in teens is systemic lupus erythematosus (lupus).
What are common symptoms of CKD in children?
CKD is often not associated with symptoms in the early stages. But as CKD gets worse, 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
Fatigue
Frequent severe headaches from high blood pressure
Anemia and pallor from decreased red blood cell production
How is CKD diagnosed?
CKD is diagnosed in 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. Often, the symptoms listed above prompt your child's doctor to run tests that lead to a diagnosis of CKD.
Based on a child's health issues or symptoms, their pediatrician may run the following tests:
Urinalysis. A child's urine will be collected to check for protein.
Proteinuria may be a sign of kidney damage.
Blood tests. Creatinine or cystatin are used to estimate the level of kidney function. Chemicals in the blood, such as potassium and sodium, as well as red blood cell counts, may be abnormal when a child has CKD. There are also special blood tests that may help diagnose specific kidney diseases such as lupus nephritis.
Ultrasound. 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.
How is the severity of CKD determined?
CKD is staged to show how much kidney function is left. Because kidney function decreases over time, the stage of CKD changes. Mild CKD is Stage 1. The most severe CKD is Stage 5. When a person is first diagnosed with CKD, it could be in any of the five stages.
A value called the estimated glomerular filtration rate (eGFR) is estimated from the creatinine blood test and is used to find the stage of CKD. Note that eGFR values are used only for CKD staging for children older than 2 years of age, because the eGFR values for children under two are normally lower due to ongoing kidney growth.
In some cases, the eGFR will need to be confirmed with other tests to be sure that the CKD stage is accurate. The kidney doctor (nephrologist) will track the eGFR and creatinine levels over time to help determine the treatment plan.
How is CKD treated?
CKD is diagnosed when there is permanent damage to the kidneys that cannot be cured. However, there have been major improvements in the care of children with CKD. These can slow the worsening of the disease and can help prevent or delay the development of CKD Stage 5 and the need for dialysis or a kidney transplant.
The main goals of treatment for CKD are to:
Treat the condition that is causing CKD
Treat complications of CKD like high blood pressure, anemia and poor growth
Slow down worsening of CKD with medications that reduce protein in the urine
In some children, prepare for eventual kidney failure (Stage 5)
Who is involved in the medical care for a child with CKD?
The child's pediatrician will continue to oversee routine healthcare, including
immunizations (vaccines). Your child's primary care provider will work with the
pediatric nephrologist who will direct the treatment of your child's CKD. Other
pediatric specialists, such as a renal dietitian and a pediatric urologist, may be included on the care team based on the child's health care needs.
Parents and other caretakers are essential members of the health care team, providing emotional support and helping the child follow the proper diet and take prescribed medications.
How does CKD usually affect a child's day-to-day activities?
Most children with CKD lead active lives. They can attend and do well in school. They can usually plan the same sports as other children.
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