Chronic kidney disease (CKD) in children is a state of mild to severe and progressive loss of kidneys’ functional capacities. Causative factors include congenital defects; blockage in the path of urine flow and subsequent reflux damaging the kidneys; hereditary diseases like polycystic kidney disease and Alport syndrome; glomerular diseases; and systemic diseases like type 2 diabetes which is affecting increasing number of children and lupus. Till the age of 4 congenital defects and hereditary diseases cause CKD in children whereas in children between 15 to 19 years of age glomerular diseases are the major cause.
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Pediatric CKD shows symptoms like fatigue due to anemia; metabolic acidosis due to uric acid accumulation; increased thirst and increased frequency of urination; disrupted electrolyte balance; secondary hyperparathyroidism due to retention of phosphorus; bone disease and hypertension in last stages. All this results in hampered growth of the child.
Diagnosis is done using blood test to find out levels of creatinine, blood urea nitrogen and glomerular filtration rate. Urine tests are also done. Specialized tests like kidney biopsy and diagnostic imaging tests are also recommended to some children.
Treatment includes careful planning and monitoring of the child’s diet, medications, tube feeding; dialysis and transplantation.
Dietary recommendations for children with CKD include:
- The quantity of protein given to the child is planned in a way that it meets the requirement of the growing body but does not create urea build up.
- Energy giving foods like fruits, vegetables, whole grains and unsaturated fats need to be taken in sufficient amounts so that the body’s muscle stores are normal and protein is not used to provide energy.
- Low salt recipes are advised. Food rich in potassium are to be avoided.
- Foods rich in phosphorus like milk and dairy products, nuts and seeds are limited in the child’s diet.
- Vitamin D supplements are prescribed to the child.
- Special nutritional supplements are recommended to children who have decreased appetite and experience nausea. This helps to meet the nutritional requirement of the children who are having problems in eating.
- In case the child fails to eat or drink properly then nasogastric tube feeding or gastrostomy feeding methods are used.
- To normalize growth in many of the CKD children with improper production of growth hormone administration of hormone injections becomes necessary.
Medications:
This includes anti-hypertensive drugs; RBC stimulating agents; phosphate binders; and multivitamin pills.
Dialysis or transplantation becomes important for those children who reach the last stage of CKD wherein the kidneys fail to remove waste products and excess fluids from the body. Either hemodialysis i.e. using a machine to clean the blood or peritoneal dialysis i.e. filtering the blood within the abdomen is done. Transplantation is a better treatment for children as post transplantation their growth and development has been found to be much better.
Emotional support for the family is very important and a group of renal social workers, dieticians, pediatricians, child life specialists etc. are usually dedicated to help the parents and the child.