A Glimpse On Chronic Kidney Disease

CKD (chronic kidney disease) is a lifelong condition in which the kidney function slowly declines over many years. It is common in adults but extremely rare in children. It can be caused by a number of conditions affecting the kidney and can present at birth or later on during childhood. All kidney conditions do not cause CKD and all kids with CKD do not always progress to the end stage. It is a complicated disease with a wide spectrum from which full recovery is not possible but timely specialist care can help your child live a long, healthy and wholesome life.

How Severe Is My Child’s Disease?

CKD is divided into 5 stages based on GFR [glomerular filtration rate- tells how well the tiny filters (glomeruli) inside your child’s kidney are cleaning the blood].

How Would Ckd Affect My Kid’s Life?

In the early stages (1,2,3), most children do not have any symptoms although they might have small shrunken kidneys on imaging or loss of protein in their urine (proteinuria).

In late stages (4,5), the kidneys function worsens and your child may develop any of the following-

• FEELING OF ILL-BEING– Your child may lose his appetite, have nausea/vomiting and feel lethargic.
• CHANGES IN URINATION- Some kids cannot produce concentrated urine and they pass large amounts of weak urine (almost with all water and few wastes). They often drink lots of water to make up for this loss.

   Other kids are unable to form much urine and pass little.

• FLUID OVERLOAD– When kidneys don’t make enough urine, water and salts build up inside the body and cause swelling(edema) in various parts of the body.
• ANEMIA- The child looks pale and tired because of reduced hemoglobin, which is an oxygen carrying molecule inside red blood cells (RBCs). This happens because kidneys no longer produce sufficient amount of a substance called erythropoietin which helps in forming RBCs.
• BONE DISEASE-Bones become less strong and may fracture. The child can also develop rickets (soft, weak, painful bones) and many bony deformities (bowed legs, curved spine). This is because kidneys are unable to activate vitamin D and maintain normal levels of calcium and phosphate in the blood.
• CHANGES IN ELECTROLYTES- Electrolytes are important chemicals needed for healthy body function. In CKD, their levels become abnormal (as kidneys do not function properly) and can result in-

1. High sodium causes fluid overload and hypertension (↑ blood pressure).
2. High potassium causes muscle weakness and cardiac arrest (heart attack).
3. High phosphate and low calcium cause bone disease and muscle cramps.
4. Low bicarbonate causes a rise in acid levels and low blood pH.

• CARDIOVASCULAR DISEASE– Children with CKD are at risk of developing diseases of heart and blood vessels which might cause sudden death. This can be due to-

1. Hypertension
2. Stiffening of blood vessels due to calcium deposition
3. Cardiac fibrosis (replacement of normal heart substance with scar tissue)
4. Cardiac arrhythmias (disordered heart beating)

What Tests Would My Child Undergo?

Your pediatrician would run the following battery of tests for further treatment of your child.

1.BLOOD TESTS– A blood sample would be obtained to check for-

• GFR-This can be estimated by measuring creatinine levels or by specific   techniques using radioactive chemicals. [Normal GFR>90mL/min/1.73m2]
• Electrolyte, protein,sugar,cholesterol levels
• Urea and creatinine (waste substances produced in body)
• Complete blood count (for anemia)
• PTH[(parathormone); tells severity of bone disease]

2. URINE DIPSTICK– A paper strip impregnated with a chemical which will change color when dipped into a urine sample containing protein/blood.

3. IMAGING TESTS-

• Ultrasound scan– A safe hand-held device emits sound waves and visualizes the kidneys on the screen.
• MCUG/VCUG-This test detects VUR. A dye is injected into the bladder via the urethra and serial X-rays are taken when your child urinates.
• MAG-3 scan-This test tells us about kidney function. A chemical is injected into a blood vessel after which a special camera takes pictures showing how much blood gets in and out of the kidneys, and how well kidneys are draining urine.
• DMSA scan– This test looks for any structural damage(scars) in the kidneys. A chemical is injected in the blood and images of urinary tract are taken by a camera.
• CT scan-Your child would lie on a bed that moves into a tunnel where multiple X-ray images are taken at various angles.

4.RENAL BIOPSY– A small piece of your child’s kidney obtained with a needle is seen under a microscope to find out the exact cause of CKD. Special medicines given at the time of biopsy would make your child sleep so that he/she feels no pain.

How Would My Child Be Treated?

Your child will require specialized medical care from a pediatric nephrologist. It is important that you regularly visit the clinic for follow-up appointments even if your child feels well. At each of these visits, the growth(height,weight) and kidney function of your child would be monitored to avoid any future complications. The medical treatment aims at-

• Reducing blood pressure [by low salt diet and medicines]
• Slowing protein loss in the urine [by medicines like ACE-I(angiotensin converting enzyme inhibitor) or ARB(angiotensin receptor blocker)]
• Avoiding bone disease [by calcium and vitamin D supplements] 
• Controlling anemia [by erythropoietin supplements or blood transfusion]
• Healthful living-

1. Ensure that your child eats at least five servings of fruits and vegetables a day. Cut down on his/her sugar and fat intake.
2. Get him/her plenty of exercise.
3. Avoid taking common medicines like ibuprofen/diclofenac without higher supervision as they cause further kidney damage.

Many children with progressive disease who develop ESRD would ultimately need dialysis, which uses special equipment to remove waste products and extra water from their body. The best treatment is a kidney transplant, in which a healthy kidney from another person is transplanted into the child. After a successful kidney transplant, the child can live a healthy life, but will need to take medicines to look after the new kidney.

What To Anticipate About My Kid’s Future?

CKD can take a heavy emotional toll not just on the kid but the entire household. Speaking with families of other children with CKD can be a huge support. Your child will need to take care of his or her health throughout life. As an adult, he/she will be supported by a new team. Due to the current medical advancements, children with CKD can reach their adulthood with better kidney outcomes. They should be encouraged to live a full and fulfilling life, pursue higher education, work and have a family.For any queries or concerns, please visit this website/contact Dr. Sethi today.