Protecting Kidneys in Kids: Essential Health Tips & Prevention

Kidney diseases in kids are rare, but some develop before birth and cause problems. Kidneys don’t just filter blood; they also perform other functions. The pair of kidneys play a main role in the development and growth of teenagers.

Any disturbance in the role of kidney function causes other health issues, including heart problems, anaemia, and oedema. So normal health of kidney function is necessary to prevent related disorders in the future.

Parents can take care of their child’s kidneys by giving them proper healthy foods and fluids. The health of kidneys ensures proper growth and development of children. 

Prevalence of Kidney Issues in Children

The rise of renal diseases in children is very rare as compared to adults. The prevalence of chronic kidney disease (CKD) in kids varies only from 0.2% to 0.3% in the overall paediatric population, as reported by NIDDK.

The NIDDK reported about 60% of CKD in children with renal failure are due to congenital defects, while 45% of cases are caused by glomerular disease in kids that are above 12 years old​.

According to NIH, CKD in kids is very rare but twice as common in boys than in girls. In North America, black kids are 2-3 times more likely to develop CKD than white kids.

According to the World Health Organisation (WHO), some disorders like nephrotic syndrome and chronic kidney disease (CKD) severely affect the child's health and decrease the quality of life.

The Anatomy and Function of Kidneys in Children

The functioning of kidneys remains the same, but changes that happen over time include improvements in the size during child development. They are reddish brown and cup-shaped pairs of organs. Each kidney is 10-12 cm long, 5-7 cm wide, and 2-3 cm thick. 

Kidneys are generally located slightly lower in children than in older adults. As the child grows, the kidneys increase in size and become more complex. So, proper nutrition and water intake are necessary to maintain the health of the kidneys in children.

The normal development of kidneys in newborns starts in the 3rd week of embryonic development, and the first glomeruli appear in the 9th week of the baby. Kidneys consist of nephrons, which are the structural unit, and each kidney contains millions of nephrons. Nephron structures are made of glomeruli, which are cup-shaped capsules covered in Bowmann’s capsule that are responsible for blood filtration. 

Kidneys ideally respond to the filtration of blood and other necessary functions from childbirth. However, improper kidney functioning can lead to disorders in children. Some children develop kidney disorders before birth (in the neonatal stage), termed congenital anomalies, and some issues appear after the birth of a newborn baby.

The reports of the World Health Organisation (WHO) show that 6% of babies are born with congenital diseases, which results in hundreds of thousands of associated deaths.

The reason for congenital anomalies (diseases diagnosed before birth) is the mother’s negligence or routine prenatal testing during foetal development. In other cases, the baby may also be born without one or both kidneys or with very small or unusually shaped kidneys (such as those with cysts or obstructions). 

The other complications that usually develop later in kids are 

• Urinary tract infections (UTIs)
• Formation of kidney stones
• Renal tubular acidosis
• Wilms tumour
• Glomerulonephritis
• Nephrotic syndrome
• Nephritis
• Hypertension.

How Common Is Kidney Disease in Children?

Paediatric kidney disorders cause stunted growth and cognitive failure in children. Kidney disease also develops in neonatal stages (before birth) and causes other problems during child development.

Congenital Kidney Anomalies

Congenital kidney anomalies are disorders that are usually diagnosed before birth. They result in the abnormalities in the structure and function of kidneys during foetal development. This disease is commonly caused by genetic mutation during pregnancy or any developmental disturbance.

A doctor can diagnose these disorders in babies before birth or after birth. The National Institute of Health reported about 6% of total worldwide babies are born with congenital disorders, resulting in hundreds of thousands of associated deaths. However, the percentage of prevalence differs from stillbirths and pregnancy cases excluded in the calculation.

Congenital kidney anomalies include multicystic dysplastic kidneys and renal agenesis. The cysts replace normal kidney tissues in multicystic dysplastic kidneys and disturb the normal working of kidneys. In renal agenesis, children are born without one or both kidneys. 

Imaging techniques, like ultrasound and MRI, are used to diagnose congenital kidney anomalies. Common symptoms are swelling in the abdomen or increased blood pressure. Depending on the disease severity, monitoring or surgical intervention of the kidneys is used in treatment. A child usually lives an average life span in mild anomalies, but in severe cases, proper treatment is required.

Urinary Tract Infections (UTIs) in Children

UTI results when the bacteria enter the urinary tract and pass to the bladder or kidneys. The other reasons for frequent occurrence in children are anatomical abnormalities, poor hygiene practices, or holding urine longer than usual.

The visible symptoms of UTI in children are fever, irritability, and pain while urinating. A urine sample is required for UTI to confirm the diagnosis through urinalysis and a urine culture test. The condition of UTI is manageable and treatable with antibiotics. For the prevention of frequent UTIs in kids, parents are advised to take care of the child with proper hygiene practices, eat a healthy diet, and have timely urination to prevent further complications.

Children with Nephrotic Syndrome

Nephrotic syndrome is a disease in which protein is observed in the urine sample. This condition is caused by the disruption of the blood vessels of the kidney, which results in the impurification of blood and the appearance of protein in the urine sample. The common symptom of nephrotic syndrome is swelling and puffiness in the feet and ankles.

They are usually diagnosed through urine tests to check proteinuria (protein in the blood). The NIDDK reports that between 1 and 3 cases occur per year in every 100,000 children, with a high remission rate.

 Acute Kidney Injury (AKI) in Children

 

Acute kidney injury (AKI) occurs when the kidneys suddenly stop working due to a lack of blood or oxygen. It can also result from dehydration, bacterial infection, accidental kidney damage, and overuse of medicines with side effects. The signs of AKI in kids show swelling in some parts of the body, such as ankles and feet, low urine output, and general weakness. 

Acute kidney injury (AKI) is treatable if diagnosed early; if left untreated, it leads to chronic kidney failure (CKD). Blood tests and urinalysis are recommended for the confirmation of AKI in children. 

About 2-5% of hospitalised children have AKI. The NIH did a meta-analysis of 94 studies on AKI in hospitalised patients. They found out that one-fourth of the hospitalised children had AKI, with an increased mortality rate. Among them, 26% were hospitalised children with AKI, 14% were moderate-severe.

 

Chronic Kidney Disease (CKD) in Children

Chronic kidney failure (CKD) is a long-term disease where the kidneys gradually lose their function.

The severity and treatment of renal failure in children depend on the five stages of eGFR values, which range from mild to severe. CKD is the last stage of kidney failure, and it takes years for the kidneys to lose function. However, some children may not experience all stages of chronic kidney disease (CKD).

Chronic kidney disease (CKD) is very rare in children compared to adults. It also leads to other complications, like anaemia, which is common in children due to low red blood cell production. Some diseases are diagnosed before birth, while others remain unidentified until infancy. According to NIDDK, the common causes of CKD in kids are congenital defects, genetics, infections, nephrotic syndrome, systemic diseases, trauma, and urinary tract infections.

Among these, congenital defects in children are the most common cause of CKD, which runs in families. These results in defects, including polycystic kidney disease and posterior urethral valves. Children with recurrent urinary tract infections (UTIs) need immediate treatment to stop the progression of CKD.

CKD affects the overall growth of kids and their quality of life. Dialysis and kidney transplants are treatment options for children as the disease progresses.

The Australian Institute of Health and Wellness (AIHW) reported that about 1-3 children per 1,000 have CKD in Australia. The prognosis for CKD treatment is dialysis and transplant.

Which Children Are More Likely to Develop Kidney Disease?

Children are more at risk of having kidney disease if are already suffering from other complications. Other complications, depending on the severity, usually progress to either acute kidney injury (AKI) or chronic kidney disease (CKD).

Children with complications like blood loss, surgery, blocked urinary tract, glomerulonephritis, and hemolytic uremic syndrome are more prone to acute kidney injury (AKI).

In another case, if the children are already suffering from Alport syndrome, long-term urinary blockage, nephrotic syndrome, polycystic kidney disease, untreated acute kidney disease, uncontrolled diabetes, and high blood pressure, it can result in chronic kidney disease (CKD).

Risk Factors for Kidney Disease in Children

Many risk factors lead to kidney disease in children and cause problems later. These risk factors are linked with other diseases and result in the severity of kidney disease in children. It includes

 

• Genetic disorders
• Congenital kidney anomalies
• Obesity
• Hypertension
• Diabetes (uncontrolled blood sugar level)
• Autoimmune diseases like lupus nephritis
• Long-term overdose of medicines, including NSAIDs and some antibiotics
• Family history of chronic kidney disease.

What are the Complications of Kidney Disease in Children?

According to American Kidney Fund, the reported common complications caused by kidney disease in children include

• Stunted growth
• Anaemia (pale colour of skin due to lower RBC production)
• Secondary Hyperparathyroidism
• Hyperphosphatemia (high phosphorus amount in the blood)
• Gout (inflammation of joints due to increased uric acid)
• Bone diseases (including arthritis and osteoporosis)
• Oedema (swelling of ankles and hands)
• Hyperkalemia ( presence of high potassium in the blood)
• Metabolic acidosis (acid buildup in the body)
• Heart diseases

What are the symptoms of kidney disease in children?

 

The symptoms of kidney disease in children depend on the severity of the disease. The acute and chronic stages of kidney disease show the following symptoms in children:

• Fatigue and tiredness due to anaemia (decreased production of red blood cells)
• Feeling cold (due to anaemia)
• Shortness of breath (due to extra fluid buildup and low RBC production in the body)
• Faintness, dizziness or weakness due to anaemia)
• Trouble while concentrating (due to the lower capacity of oxygen-carrying cells)
• Swelling in legs, ankles, feet, or hands and puffiness of face (due to extra fluid buildup)
• Ammonia-like breath and food taste changes due to uraemia (the buildup of wastes in the blood)
• Frequent or no urination due to failure of kidneys, especially at night
• Foamy or bubbly urine due to an increased amount of protein in the urine.
• Change in urine colour (brown, red, or purple urine) due to renal failure and may also contain blood.
• Feeling pain while urinating due to pressure on kidneys.
• Stunted growth of children is due to decreased production of growth hormones.
• Increased blood pressure due to disturbance in the regulation of blood pressure released by kidneys
• Repeated urinary tract infections (UTIs) due to kidney infections.

As the condition progresses, people also face the following symptoms:

• Muscle cramps or twitches due to weakness and muscle wasting
• Visible brown spots on the skin 
• Amenorrhoea in females (absence of menstruation bleeding)
• Bloody diarrhoea (blood in the stool) due to renal failure.
• Deficiency of vitamin D leads to joint pain and other bone diseases like arthritis.
• Worsening of swelling, e.g., hands, feet, ankles, and increased puffiness around the eyes. 
• More prone to get infection (due to decreased immunity)
• Itchiness (irritation or dryness of skin due to wastes in the blood)

 

These symptoms also indicate other health conditions. Therefore, it is necessary to confirm the diagnosis and severity of kidney disease in children for timely management. 

What are the Most Common Causes of Kidney Failure in Children?

The most common cause of kidney failure in children depends on the severity of the disease. The common causes of kidney failure in children are

Congenital anomalies: Congenital kidney anomalies occur during the development of the fetus and affect 30–50% of total paediatric CKD cases. The child born with congenital kidney anomalies may have the following conditions:

• Horseshoe kidney: The pair of kidneys might be fused naturally and form a single-arched kidney
• Polycystic or multicystic kidney disease: One or both kidneys are filled with fluid and form a cyst.
• Renal agenesis: A baby is born without a single kidney or absence of both kidneys naturally.
• Renal hypoplasia: The baby is born with one or two abnormally small kidneys
• Renal dysplasia: One or both kidneys are not properly formed as they should

The other causes of renal failure also include

• Autoimmune kidney disease: Lupus nephritis is an autoimmune kidney disease in which the immune system attacks the body cells and organs. It also damages the kidney cells of children and results in kidney failure.
• Severe dehydration: Dehydration results in the formation of kidney stones and urinary tract infections in children. It also causes a buildup of waste in the body that leads to kidney failure.
• Nephrotic syndrome: The nephrotic syndrome is caused by the inflammation of the glomerulus that results in protein leakage from the blood into the urine. The presence of protein in the kid’s urine shows nephrotic syndrome that requires immediate treatment. If left untreated, it damages the kidneys and leads to kidney failure.
• Uncontrolled diabetes: It is the leading cause of renal failure in adults but is not common in children. Increased blood sugar levels damage the blood vessels and nephrons of the kidney, which filter waste. If left untreated, it results in kidney failure.
• High blood pressure: High blood pressure narrows and restricts the blood vessels of the kidneys. It results in increased pressure to filter the blood. The consistent high blood pressure leads to kidney failure in children.
• Vesicoureteral reflux: The backwards flow of urine from the bladder into the ureters and sometimes to the kidneys damages the muscles and results in peadiatric renal failure.
• Hydronephrosis: It is caused by any obstruction in the urinary tract. When the urine flow is obstructed for any reason (it might be due to stones), the urine flows back to the kidneys and increases the pressure on the internal structure, resulting in child’s kidney failure.

• Repeated kidney infections (like AKI): Kidney infections lead to potential complications. Acute kidney injury is treatable, but if left untreated, it progresses to renal failure gradually.

• Glomerulonephritis: It is inflammation of the kidneys' glomerulus that causes problems while urinating, and swelling contributes to kidney failure. 

Prevention and Maintenance of Kidney Health in Children

Chronic kidney disease is irreversible, but it can be prevented towards disease progression through early diagnosis and managing its symptoms.

Healthy Diet and Nutrition

It is important for children to eat a proper diet and obtain the required nutrients through healthy food. This helps maintain kidney health and improves children's living standards. 

 

• Avoiding excessive fat and caloric intake is essential to maintaining a healthy body weight because it leads to other health complications. 
• The excessive intake of sugar also increases blood sugar levels, which puts a strain on the kidneys. 
• The NIH reported that diabetes is the leading cause of kidney failure in adults. As such, restricting the consumption of sodas, carbonated sweeteners, juices, and sports drinks prevents the likelihood of chronic kidney failure. Children should also avoid sugar-containing foods, including bread, processed food, and canned items.

 

The NIH stated that obesity causes problems in later years and results in other diseases, such as diabetes, kidney and heart disease. Therefore, it is important to take a healthy diet and maintain a healthy weight to avoid kidney-related complications.

Hydration and Fluid Management

For fluid management, proper hydration and drinking water are necessary to maintain excellent kidney health. 

• Water removes extra water and waste from the blood in the form of urine. 
• It also facilitates blood flow to the kidneys and other organs and ensures normal body functioning.
• Increased water intake, especially in hot weather, helps prevent dehydration, which can cause fatigue and lethargy in children. Moderate dehydration disrupts normal body functions, and severe dehydration can lead to kidney failure.
• When the hydration status is normal, the child easily excretes light-coloured urine. However, in dehydration, the child excretes darker urine with a pungent smell.

Regular Physical Activity

• Walking, playing and other physical activities are necessary to protect kidneys and other activities that improve overall well-being.
• Other physical games, such as cricket and football, activate the body’s major systems, including the skeleton, muscular, joint, cardiovascular, and renal systems.
• Parents should reduce or limit children's screen time, including TV, smartphones, tablets, and computers, to encourage physical activity.

Avoiding Kidney-Related Risks

Kids should avoid taking too much medicine to maintain kidney health. Overusing painkillers is bad for kidney health. Taking OTC medicines without a doctor’s prescription should be strictly prohibited. Parents should read the labels of medicines carefully and not take more than the recommended dosage. Also, drink plenty of water while taking medicine to avoid other risks.

Routine Health Check-ups

Regular checkups for kids help in the early detection and diagnosis of any disease. Get an appointment immediately if the child is feeling tired, having difficulty sleeping, has a poor appetite, has urinating problems, or has swelling or puffiness around the eyes.

The diagnosis of kidney disease in kids starts with physical examination, physical symptoms like swelling and medical history. Kidney functions are further evaluated through blood tests and urinalysis to confirm the diagnosis. Renal scans and other tests like ultrasound, CT scan and MRI are also done to diagnose kidney problems.

Prevention is crucial in reducing the complications of chronic kidney disease (CKD). According to the Centers for Disease Control and Prevention (CDC), children who eat healthy food and drink plenty of fluid have a 2% lower incidence of chronic kidney disease than those who don’t. Kids who are already in at-risk groups, such as the obese or diabetic, are included.

Diagnosis and Treatment of Paediatric Kidney Disorders

Diagnostic Procedures

These are the standard procedures to diagnose chronic kidney disease (CKD) in kids.

• Blood tests: Doctors perform blood tests to diagnose kidney problems. They use creatinine, cystatin, and eGFR values to assess kidney function. Other abnormal values in blood tests like sodium, potassium, and RBC count also indicate CKD in the kidneys. Blood work also helps to evaluate kidney conditions like nephritis disease, known in kids as lupus nephritis or systemic lupus erythematosus.

• Urinalysis: In urinalysis, the urine sample of kidneys is taken to observe the presence of protein in the urine. 

• Imaging Tests: Imaging tests also help diagnose kidney problems. They include MRI and CT scans, which provide structural abnormalities to identify the main issue.

• Kidney biopsy: In a kidney biopsy, a small piece of kidney tissue is removed during a surgical process to examine it under a microscope. This helps identify kidney disease and determine its cause. 
• Genetic tests: Genetic tests are rarely used to diagnose children’s CKD, but gene mutations are observed in these tests to find the cause. Genetic testing also helps determine any congenital anomalies that cause chronic kidney disease (CKD) in children.

Accurate diagnosis and management of CKD complications are essential for treating paediatric kidney disease. Accurate diagnosis helps slow the progression of the disease and prevent kidney failure. The NIDDK reported that the success rate of CKD in children and adults is up to 85–95% on timely diagnosis.

 How do healthcare professionals treat kidney failure in children?

The treatment depends on the severity of the child’s condition and the values of the kidney disease's eGFR. The goal of healthcare professionals' treatment is to manage symptoms, support kidney function, and maintain the quality of life. The treatment of chronic kidney disease depends on the following factors:

• Children's age 
• Overall health
• Medical history.
• The severity of the disease.
• Tolerance of specific medicines and therapies.
• Personal preferences

These are common treatment methods for chronic kidney diseases, depending on the cause.

• Medications or diuretic therapy to increase urine production or for diabetes, hypertension or anaemia
• Dialysis
• Kidney transplant
• Lifestyle modification and specific diet restrictions

Medications

Healthcare providers usually prescribe ACE inhibitors and diuretics for renal failure. ACE inhibitors lower blood pressure and reduce protein loss, while diuretics reduce swelling and remove excess fluid from the blood. Other medications include erythropoiesis-stimulating agents, phosphate binders, growth hormones, antibiotics for infections and iron supplements for anaemia in children. In severe cases, medications don’t work, and children with renal failure need dialysis and kidney transplants.

Medicines are usually prescribed to manage other symptoms that are related to kidney failure. It includes 

 

Other complications	Medicines	Medicine Usage
Diabetes	Insulin, metformin, and finernone.	Lowers blood sugar level
Hypertension	ACE inhibitors, Angiotensin receptor blockers, beta-blockers, and diuretics.	Lowers blood pressures
Heart Diseases	Diuretics, ACE inhibitors, Beta blockers, potassium binder	Treat heart-related complications like lowering blood pressure, helping kidneys to get rid of excess salt and water and removing excess potassium from the blood.
High Cholesterol	Statins	Lowers blood cholesterol and helps blood flow pass easily
Anaemia	Iron supplements, Erythropoiesis-stimulating agent (ESA)	It helps the body to make red blood cells and prevent anaemia.
Metabolic Acidosis	Sodium bicarbonate	It keeps the balance of the acid in the blood and helps slow kidney disease.
Bone Diseases	Phosphate binders, calcium and Vitamin D	It helps to balance the calcium and vitamin D in renal failure patients.
Secondary hyperparathyroidism	Calcimimetic, calcium or vitamin D supplements	Helps to balance the calcium and vitamin D in renal failure patients.

 

Dialysis

Kidney disease is treated with medications or dialysis. There are two types of dialysis: hemodialysis and peritoneal. Children on dialysis should follow a low-potassium and low-salt diet. The type of dialysis depends on the severity of kidney disease.

Haemodialysis is a procedure in which the blood is artificially cleansed in patients whose kidneys can’t function. This requires the use of a dialyser. Peritoneal dialysis is where the lining of the abdomen filters the blood. The peritoneal membrane acts as a filter, with dialysate solution inserted to absorb waste and fluid through diffusion and osmosis, which is later drained.

Healthcare professionals recommend dialysis in renal failure cases when medicines are no longer effective. The National Kidney Foundation reported that a person is required to start dialysis when the kidney function drops to 15% or less. The dialysis should immediately begin in  Stage 5 kidney disease (severe case), with a glomerular filtration rate (GFR) of less than 15 mL/min.

The NIH highlighted the values of creatinine that indicate the need for dialysis. When the creatinine clearance (CC) reaches below 10-12 cc/minute, the patient needs dialysis. There are two types of Dialysis: haemodialysis and peritoneal dialysis. 

Kidney Transplant

A kidney transplant is another way to treat damaged kidneys after dialysis. In a transplant, a damaged kidney is replaced with a healthy one, and the transplanted kidney doesn’t need dialysis. Depending on compatibility, children can take a kidney from a living or deceased donor. The process is faster if the child finds a kidney from a living donor.

Lifestyle Modification and Specific Diet Restrictions

Lifestyle changes and some diet improvements can help children’s renal health. Physical activities like walking, running, playing cricket or football give children more things to do.

Dietary modification includes strict control of protein, sodium, potassium and fluids. Children with chronic renal failure must restrict phosphorus from food and take vitamins and minerals as part of their treatment. Eating healthy food with the proper nutrients in the right proportion helps children grow and be healthy.

Dietary management

Healthcare providers usually prescribe diets low in sodium, protein, potassium, and phosphorus.

• Pediatric diet recommendations often include more tailored nutrient restrictions depending on individual cases. 
• Fruits rich in phenols, which can enhance kidney function, are particularly beneficial for renal patients. Examples include apples, cranberries, blueberries, and strawberries.
• Kids with renal failure should avoid processed foods and high-sugar drinks like colas and soft drinks.

Emerging Treatments and Research

Recent Advances in Paediatric Nephrology highlighted the progress made in new treatment options within the field. Over the last few decades, researchers have noted significant advancements in managing kidney diseases. 

New treatment methods have improved the care for various conditions, including complications from lupus nephritis, growth failure, high blood pressure, atypical hemolytic-uremic syndrome, and acute rejection. Innovations in pharmacology and drug discovery have enabled these treatment advancements.

• Children with chronic kidney disease can live because of dialysis and kidney transplants.
• Molecular biology, genetics, bioinformatics, and imaging have made early diagnosis and treatment of many common nephrology conditions possible, including CAKUT, cystic kidney disease, lupus, hereditary nephritis, and hypertension.
• Renal function biomarkers have moved from the bench to the bedside.
• New renal replacement machines are available for lupus, haemolytic uremic syndrome, neonates, and preemies.
• Treatment for recurrent transplant kidney nephrotic syndrome and resistant native kidneys has advanced.
• Paediatric renal patients can also get updated on white coats, masked and neonatal hypertension.
• Updates on Alport syndrome management and classification and antibiotics for foetal hydronephrosis will benefit every paediatric nephrologist.

Chronic Conditions

Parents must follow these rules to manage chronic conditions. These rules are key to maintaining kidney health with other comorbidities. It involves long-term management strategies that prevent future complications and manage symptoms.

Multidisciplinary teams and counseling are important for managing chronic conditions in paediatric renal health. Psychological support for children and families helps to satisfy patients and plays a big role in recovery.

Long Term Management

Long-term management of chronic conditions is important for a child's health. This includes routine monitoring and lifestyle modifications to manage complications. Regular review of kidney disease progression, symptom management, and adjustment of care plan will stabilise the condition.

• Routine Check-up: To monitor kidney function, parents need to take blood tests for creatinine, serum, electrolytes and urine, which may require urgent action.
• Lifestyle Changes: In most cases, diet modification, increased activity, and fluid management can improve CKD management. A registered dietitian with renal expertise can also help develop a personalised nutritional plan.

Monitoring Kidney Function Over Time

Monitoring involves regular kidney function assessment to watch out for progression and complications.

• GFR Monitoring: Estimating the glomerular filtration rate (eGFR) is an important measure of kidney function. eGFR is one of the key tests for assessing kidney health, and a decline in eGFR can indicate the progression of kidney disease.
• Regular Imaging: Ultrasound and MRI visually represent structural abnormalities in kidneys. These tests help understand kidney anatomy and any changes that may occur over time, such as increased kidney size or stone formation.

Addressing Other Complications 

Healthcare providers should also manage other diseases tht are linked with kidney failure. This includes managing conditions like diabetes, high blood pressure, and other cardiovascular issues. High blood pressure is the most common complication of chronic kidney disease (CKD) in children.

• Blood Pressure Management: Parents are responsible for monitoring the blood pressure levels of children. High blood pressure in children is usually managed with lifestyle modifications and anti-hypertensive drugs like ACE inhibitors or calcium channel blockers (CCB)
• Screening for Other Complications: Patients with CKD are more likely to suffer from other diseases like diabetes, osteoporosis, and anaemia. So, screening is important in children with CKD  to timely identify other co-morbidities and treat them accordingly.

Psychological Support for Children and Families

For a child and their family, life with a chronic condition is difficult. In this case, mental satisfaction and positive thoughts motivate a rapid recovery. Counselling and psychological support are essential.

• Counselling Services: Mental health professionals and experts provide special counseling services for chronic illness to assist children and families. It motivates them to cope with the psychological impact of a long-term condition.
• Support Groups: The encouragement for families to be involved in a support group can offer them a positive feeling of community and shared experience.

Role of Multidisciplinary Healthcare Teams

A multidisciplinary team involves a team of professionals who are responsible for recovering the health of children with collaboration.

• Team Composition: The interdisciplinary team includes nephrologists, dietitians, nurses, social workers, and members of the mental health profession. They develop proper care plans for child fastest recovery and active participation. 
• Collaborative Care: The team gathers at least once a week to discuss the child’s needs with the family regarding chronic illnesses. Doctors ensure collaborative care and use a physician-led approach to care management.

For Example:

Various studies were conducted to observe the effects of interventions on children with CKD. They showed that proper care and management ensure the fastest recovery of paediatric patients with kidney diseases.

According to the National Kidney Foundation, early diagnosis, treatment, and follow-up help slow down kidney function and its complications.

Impact of Paediatric Kidney Health on Growth and Development

1. Physical Growth

Kidney health ensures the proper growth and development of children. Kids with kidney issues often grow slowly compared to normal children. The NIDDK highlighted the common issue of growth failure that is linked with chronic kidney disease (CKD). As a result, these children might be shorter than their age peers. The NIDDK also noted that approximately one-third of children with moderate to severe CKD who fall below the 3rd percentile will be shorter than 97% of other children in their age and sex group.

1. Cognitive and Emotional Development

Another study published in the Clinical Journal of the American Society of Nephrology shows that children with CKD typically have cognitive abilities that range from low to average compared to their age peers with healthy kidneys. These children often face mild challenges in academic skills, have lower executive functions, and struggle with both verbal and visual memory.

1. School Performance and Social Interaction

As reported by UCSF Benioff Children's Hospitals, children with CKD often miss school due to frequent medical appointments. This limits child involvement in extracurricular activities and leads to social isolation from friends, which affects academic performance and hinders their learning process.

1. Nutritional Needs for Optimal Development

Children with CKD require personalised nutritional support to promote healthy growth. They also require a customised diet plan to fulfil their caloric needs while restricting foods high in sodium, potassium, and phosphorus. To prevent nutritional deficiencies and meet caloric requirements, healthcare providers often suggest vitamins and minerals to prevent further complications like anaemia.

Support Systems and Resources

Importance of Support System 

Support from family, schools, and the community plays an essential role in the recovery of children with renal failure. When families take the initiative to learn about their child's condition and actively participate during recovery, they can effectively manage their child’s condition. Schools should acknowledge and address the needs of children with chronic illnesses, ensuring they have the resources and support necessary for their education.

For Example:

Various studies highlighted a connection between the growth and development stages of kidney health. Findings from the NIDDK highlight that kids with chronic kidney disease (CKD) are more prone to developmental anomalies and poor academic performance than healthy kids.

The NIDDK statistics showed that children diagnosed with CKD perform below average in academic tests, and their social skills development also falls short of expectations.

Advances in Paediatric Kidney Health Research

Modern technology is also helping with paediatric kidney diagnosis. New technologies are being introduced to treat and alleviate patient concerns and achieve good outcomes. These include genetic research, personalised medicine, and regenerative medicine to fix kidneys.

Genetic Research and Personalised Medicine

Advancements in genetic research help in understanding paediatric kidney diseases, and personalised medicine has also been introduced to meet individual children’s needs for better outcomes.

This is specific to individual genetic profiles and involves genetic testing and pharmacogenomics.

Genetic Testing: Whole-exome sequencing is used to find gene mutations. These genes are associated with kidney diseases, and genetic research helps identify the specific kidney disease. Genetic research allows early diagnosis of kidney disease and targeted therapy. This also helps manage genes associated with congenital anomalies.

Pharmacogenomics: Pharmacogenomics gives us a detailed understanding of genetic variations that affect drug metabolism. It has benefits and personalised medicine reduces side effects. It’s used to treat kidney diseases like nephrotic syndrome.

 

New Diagnostic Technologies

Imaging techniques show ways to diagnose kidney diseases and biomarkers for early detection of renal diseases.

Advanced Imaging: Imaging is a noninvasive method of treatment with improved sensitivity and specificity in MRI and ultrasound. Advances allow the diagnosis of structural abnormalities in kidneys with improved sensitivity for better outcomes.

Biomarker Discovery: Biomarkers in urine and blood are used to check kidney function and disease progression. For example, urinary biomarkers can identify kidney disease, which can predict acute kidney injury (AKI) in paediatric patients.

Advancements in Treatment Modalities

The latest technology has introduced advanced methods to treat chronic kidney disease in children.

Improved Dialysis Techniques: 

Portable dialysis devices are the biggest advancement in the field. They are bag-pack-like devices that give children more mobility and flexibility for better-scheduled treatments and better outcomes. This kind of innovation improves the quality of life and is designed for children to make treatment safer and more efficient.

Transplant Innovation: Advances in kidney replacement technology are improving the outcome of paediatric kidney transplants. Innovations in kidney replacement technology include implantable bioartificial kidney (BAK) and kidney regeneration technology. Both technologies aim to replace normal kidney functions fully, address donor organ shortage and prevent complications from dialysis and immunosuppressants. These methods ensure better donor organ matching and immunosuppressive therapy to reduce rejection rates and minimal side effects.

The NIH also mentioned new immunosuppressive agents. Immunosuppressants, including the JAK inhibitor tofacitinib and the mTOR inhibitor everolimus, have already been approved for use and have shown good results.

Regenerative Medicine and Kidney Repair

 

Regenerative medicine and kidney repair methods have the potential to restore kidney function. These approaches include stem cell therapy and tissue engineering, which aim to convert damaged kidney cells into healthy ones. 

• Stem Cell Therapy: This treatment is still under investigation for chronic kidney disease (CKD). It shows promise in regenerating damaged kidney tissue and helping children with CKD return to a healthier state. 
• Tissue Engineering: Due to advancements in bioengineering, doctors can now create structures that serve as artificial kidneys. In the future, this technology may repair damaged kidney tissues in natural kidneys. 

Future Directions and Ongoing Studies

New treatments and ongoing research are focused on achieving better outcomes with fewer side effects. 

• Clinical Trials: Current studies are exploring innovative treatments and interventions, such as gene therapy for genetic kidney diseases and new medications targeting pathways that lead to kidney damage. 
• Collaborative Research Initiative: A global effort among various institutions aims to facilitate these studies and establish future treatment protocols to enhance patient care. 

Research published in Paediatrics and The Journal of the American Society of Nephrology indicates promising developments in genes and treatment strategies for pediatric kidney disease. 

The NIDDK highlights that early intervention and personalized care can improve children's health outcomes, including faster growth and reduced hospitalization rates. 

Resources and Support for Paediatric Kidney Health

More resources are required to be dedicated to pediatric kidney health. Families should have access to these tools to manage kidney disease effectively in children. 

Educational Materials for Parents and Caregivers

Various resources are available to assist everyone. Parents and caregivers can find valuable information through books, websites, and brochures. Notable e-books include "Paediatric Kidney Diseases" by Franz Schaefer and "Pediatric Nephrology On-The-Go" by Hui-Kim Yap, which comprehensively cover all aspects of kidney diseases in children.

Support Groups and Counselling Services

Support groups and counseling services also provide informative sessions for families with paediatric health issues. Kidney Care UK offers free help, emotional support and counseling to kidney patients and their families.

The support group also helps build relationships with other families and a sense of belonging through community. Kidney Health Australia has a peer support group programme for renal patients.

Financial Assistance and Insurance Information

Dialysis and kidney transplants are expensive, and most families can’t afford the costs. In this case, families can get help from financial assistance programmes.

• Financial Assistance Programs: Some organisations and charities offer financial help for medical expenses, medications, and treatment costs for those in need. The Australian Government Department of Health and Aged Care and Kidney Health Australia have these assistance programs.
• Insurance Information: Families looking for insurance can find information on how to access these policies on the NIH, GMHBA, and CARI guidelines. The guidelines have the navigation process and policies with benefits, options, and claims processes.

Healthcare Providers and Specialists

Qualified healthcare providers care for children. Paediatric nephrologists and healthcare companies manage kidney health and treat all kidney diseases in children. Other healthcare service providers, such as nurses, social workers, and dietitians, also care for children’s kidney health.

Online Resources and Advocacy Organisations

There are many free online resources available.

The online sources that have authentic information are the Australian Institute of Health and Welfare, NIH, Mayo Clinic, Healthline, Cleveland Clinic and National Kidney Foundation, which provides educational content and support services for kidney health.

Frequently Asked Questions (FAQs) on Paediatric Kidney Health

What are the most common kidney disorders in children?

The most common kidney problems in children are congenital kidney anomalies (birth defects), UTI, nephrotic syndrome, kidney stones, glomerulonephritis, AKI and CKD. Each needs to be treated accordingly.

How can I prevent kidney problems in my child?

You can prevent kidney problems in your child by promoting hydration, reducing sugar, eating low-sodium foods, and avoiding processed foods. Early detection through regular check-ups and good hygiene practice will also prevent UTI recurrence in children.

What symptoms indicate a kidney issue in a child?

Symptoms of kidney disease vary depending on the type and severity of kidney disease. Common symptoms in children that indicate kidney problems are

• Frequent urination or decreased urine output
• Pale colour due to anaemia
• General weakness or fatigue
• Swelling of the body due to fluid retention
• Puffiness of eyes
• The presence of blood in the urine
• Difficulty in sleeping

How are paediatric kidney diseases diagnosed?

Paediatric kidney disease is diagnosed through blood and urine tests after physical examination and medical history. In the blood test, eGFR values are observed, and the presence of protein in urine helps diagnose kidney disease in children.

What treatments are available for children with kidney disease?

Treatment for kidney disease depends on the condition and severity. Standard treatment is medicines given to children to manage symptoms and treat UTIs. For end-stage renal disease (ESRD) in children, dialysis and kidney transplants are recommended.

How does kidney health affect my child’s growth and development?

Stunted growth is a common problem in children with kidney disease. Kidneys are responsible for overall growth and development. If kidneys are not functioning correctly, growth delay occurs due to hormonal imbalance. Chronic health issues can also lead to cognitive challenges.

What lifestyle changes can support my child’s kidney health?

A healthy lifestyle, such as increasing physical activity and water intake for your child, healthy eating habits, and restricting unhealthy foods high in sugar and sodium, can support overall kidney health in paediatrics.

Are there any new advancements in treating paediatric kidney disorders?

There are many new developments to treat kidney disorders, like renal replacement therapy (RRT), ongoing research on genetics, and new diagnostic technologies for better outcomes. These treatment methods can diagnose disease more accurately. They also focus on stem cell therapy to get better results in children.

What resources are available for families dealing with kidney disease in children?

Many resources are available online, and some organisations, like the National Kidney Foundation, have support groups for families with kidney disease. Educational materials from health organisations also offer comprehensive care and financial assistance.

How can schools support children with kidney health issues?

Schools can support children's kidney recovery by creating individualised education plans (IEPs). Teachers and school principals can address medical needs and provide proper counseling services. This helps build stronger connections between families and schools, which results in the fastest recovery of affected kidney children. 

 Who is involved in the medical care of a child with CKD? 

The medical care team involves health care professionals, including paediatricians and nephrologists, to ensure proper treatment of children with CKD. Other healthcare professionals also include a social worker, a mental health professional, and a registered dietitian.

What is Nephrotic Syndrome?

Nephrotic syndrome is a kidney disorder in which the kidneys are unable to filter blood, resulting in excessive protein passing through the urine. It is usually caused by damage to clusters of blood vessels in the kidney, which results in swelling and leads to other health problems. 

What are systemic diseases that cause kidney disease?

Systemic diseases affect more than one part or organ of the body. Systemic diseases that cause kidney disease are diabetic nephropathy, lupus nephritis, congestive heart failure, HIV, liver disease, and dysproteinemia.

What is kidney trauma or injury?

Kidney trauma or injury occurs when the kidneys are injured by external force. It results in injury in the parenchyma or renal vasculatures of the kidneys, which causes bleeding to the collecting duct.

What are the Problems with the Urinary System?

The problem with the urinary system can lead to bladder infections caused mainly by bacteria, also known as cystitis. It also leads to urinary tract infections, the formation of kidney stones, prostrate problems in men, and bladder control problems.

What Can I Do to Keep My Child’s Kidneys Healthy?

Water is essential to maintaining normal kidney function. It helps the kidneys remove waste and extra fluid from the body in the form of urine. In addition to hydration, reducing sugar and salt intake, exercise, and regular check-ups can help ensure kidney health in children. In the case of CKD, it is recommended to consult a healthcare professional for specific diet restrictions depending on the severity of the disease.

Clinical Trials for Kidney Disease in Children

Clinical trials are research studies that test medical, behavioural, and surgical interventions to achieve better results. They are necessary for children as they help healthcare professionals diagnose and discover the best possible treatment. Clinical trials also allow the creation of child-specific medicines and therapies to treat the severity of the disease.

Why are clinical trials with children important?

Clinical trials are important as they help researchers discover the best possible method for treating children. Children respond differently to every medicine and therapy compared to adults, so these clinical trials are helpful for children to prevent and treat kidney disease accordingly.

How do I decide if a clinical trial is right for my child?

It is recommended that you consult health care professionals, including nephrologists and paediatricians, to make a decision related to a clinical trial. You should consider factors like the trial's safety measures, possible side effects, and how it impacts your child's daily life.

What Aspects of Kidney Disease Are Being Studied in Children?

Several aspects related to kidney diseases, including the cause of disease, diagnosis progression, and the effect of medicine and lifestyle changes, are being studied in children. Researchers are also paying attention towards the genetics of kidney diseases to prevent and reduce the risk of kidney damage in children. 

What Clinical Studies for Kidney Disease are Available for Child Participants?

The North American Paediatric Renal Trials and Collaborative Studies (NAPRTCS) featured clinical trials related to paediatric kidney disease, including dialysis, transplantation, and chronic kidney disease stages​. The National Institutes of Health (NIH) also runs paediatric trials on new treatments for kidney disease, testing medications, lifestyle modifications, and emerging treatments like gene therapy.