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Pediatric Kidney Disease

By Dr. K'Joy Simms, Pediatric Nephrologist

Kidney disease can and does occur in children. Pediatric kidney disease presents a unique public health challenge as it is relatively rare but often severe with various etiologies. It is usually overshadowed by kidney disease in the adult population where it is more common and burdensome. However, pediatric kidney disease certainly requires the same level of awareness an advocacy as adult disease because of the implications on growth, development, quality of life, and burden to the public health care system.

Many children with kidney disease go on to have chronic kidney disease (CKD) or chronic renal disease. In this condition, the kidneys are permanently damaged, do not get better with treatment, and worsen over time. Ultimately, the child may require renal replacement therapy in the form of dialysis or transplantation. Kidney disease affects approximately 1574 children per 1 million and all ages and races are affected. Over the past 20 years, the incidence of chronic kidney disease in children has steadily increased.

The kidneys are two bean shaped organs that are located below the ribs. They are responsible for filtering the blood of waste and extra water and produce urine to get rid of these. But it doesn’t stop there. The kidneys are also responsible for removing extra acid from the body and maintaining a healthy balance of salts and minerals. The kidneys make hormones that control blood pressure, make red blood cells, and interacts with a hormone that promotes healthy growth. With this understanding, it is very easy to understand how CKD can lead to myriad of problems in childhood. Children with CKD may have no symptoms at all. If they do have symptoms, they may include swelling because of decreased urination, some disease may cause frequent urination or prolonged bedwetting, poor growth, loss of appetite, nausea, fatigue, headaches related to elevated blood pressure, and anemia from decreased red cell production.

The medical challenges are only the start of the story. As one may expect, kidney disease has a tremendous impact on the quality of life for the child and the family members. Children often struggle to achieve independence from their parents because of the complexity of their health condition. Additionally, they often encounter relationship problems, learning and behavior problems, and have delayed language and motor skill development. Other siblings in the household may suffer neglect because of the amount of support that is required to care for a child with CKD.

The cause of kidney disease in children is very different from the more common causes in adults. Infants and children are more likely to suffer from birth defects, congenital

, and hereditary disease. Teenagers are affected by glomerulonephritis which occurs because of swelling and inflammation of the kidney, infect ion, nephrotic syndrome, and urine blockage or reflux. Many causes of CKD in adults have their origins in childhood. The obesity epidemic in childhood has given rise to the increased prevalence of noncommunicable diseases in children. Obesity often leads to hypertension and diabetes, both leading causes of CKD in adults.

Even with the best treatment, pediatric CKD patients have increased morbidity and mortality when compared to their age matched peers. Children with CKD have a shortened lifespan compared to children without kidney disease. Those that require dialysis have a mortality rate that is 30 times higher than other children. The leading cause of death is usually related to cardiovascular disease or infection.

The importance of CKD and kidney failure in children should not be understated as it carries with significant impact. Kidney transplantation is the preferred form of renal replacement therapy in children as it can help with maximizing their growth, development, and increases their survival with compared to dialysis. While there is no cure, renal transplantation provides as close to a second chance as is humanly possible. Every child should have a second chance!

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