What is Chronic Kidney Disease?

Chronic Kidney disease is a chronic condition in which the kidneys are permanently damaged, and the kidney function decreases. Typically, it gets worse over time. It is now a prevalent problem worldwide with increasing incidences being reported.

According to the Improving Global Outcomes (KDIGO) guidelines CKD has been defined as abnormalities of kidney structure or function, present for more than 3 months, with implications to health.

However, this definition is meant for adults, as CKD in children presents risks, symptoms, and complications very specific to paediatric age. It could also affect their growth and quality of life later on in adulthood.

Chronic Kidney Disease or CKD is also called Chronic Renal Disease or Chronic Renal Failure.

What causes CKD in children?                

Though CKD is way more common in adults, there has been an alarming rate of occurrence in children. There are multiple causes that might cause CKD in children. It could be caused due to malformation of kidney, or presence of scar tissues that affect the normal functioning of kidneys. It might also be a congenital problem and be present since birth.

Chronic Kidney Disease might be caused as a result of nephrotic syndromes. Nephrotic syndromes are a collection of symptoms that include abnormal levels of protein and albumin in the body. It can also cause swelling due to the body retaining too much fluid, as well as high blood cholesterol.

Sometimes, in severe cases, nephrotic syndromes can lead to a serious condition called Focal Segmental Glomerulosclerosis (FSGS). This causes severe scarring of tissues that can worsen over time as a result of more scar tissues forming when the kidney gets strained. Other issues that cause scaring of tissues can also cause CKD.

Other reasons that might lead to the development of CKD include:

• Some cancers
• Lupus or other autoimmune diseases
• Side effect of medication or treatment for other conditions

Common symptoms of CKD in children

Detecting Chronic Kidney Disease in children is notoriously hard because it is often clinically asymptomatic, especially in the earlier stages, and even when symptoms are present they are very general. This causes the disease to worsen over time which makes it harder to treat and control.

Some common symptoms of CKD include:

• Fatigue
• Loss of appetite
• Trouble sleeping, restless leg syndrome
• Fever
• Pallor and anaemia
• Headache due to high blood pressure
• Chronic nausea

Some more symptoms that might appear as the disease progresses include:

• Puffiness around eyes, feet, and ankle
• Frequent urination, and prolonged bed-wetting in children who are 5 years and older
• Stunted growth as compared to children of same age group

Problems associated with CKD in children

As mentioned previously, CKD in children brings forth a very unique set of issues that can affect their adult life as well. This is also a reason due to which it is a hard problem to deal with. Some problems that commonly show up in children suffering from Chronic Kidney Disease are mentioned below.

• Growth impairment– Due to the multiple dietary restrictions that are placed on a child with CKD, the nutrient is often not enough for growth. Growth impairment may be caused due to malnutrition, metabolic acidosis, mineral and bone disorders, anaemia, and fluid and electrolyte abnormalities. There is also a disturbance in the release of growth hormones during infancy and early childhood, which can cause impaired growth.
• CKD-MBD– Chronic Kidney Disease- Mineral Bone Disorder is diagnosed as a result of abnormal levels of calcium, phosphorus, parathyroid hormone, or vitamin D metabolism as well as abnormalities in bone histology, linear growth, or strength, and vascular or other soft tissue calcifications. This can affect bone health, growth, as well as final adult height, as well as brittle bones.
• Neurocognitive impact– Adults who have dealt with childhood-onset of CKD have been reported to face problems with emotional, social, as well as functional aspects of life. They also might show anxiety and depression related symptoms. They might experience weakness, low energy, as well as day time sleepiness, which can affect the quality of life.
• Cardiovascular complications and Death– This is a problem that is common for both adults and children suffering from CKD. Cardiovascular problems might show up early in the course of renal failure, and it tends to progress rapidly as the dialysis is carried out. The cardiac issues in children that results in higher mortality rate include problems like arrhythmia, valve diseases, cardiomyopathy, as well as cardiac arrest.

How to diagnose CKD in children?

Since there are almost no obvious symptoms for Chronic Kidney Disease, it is important that in case of any abnormalities during routine check-ups, a thorough investigation is immediately conducted. It is important to remember that CKD is much more manageable in earlier stages.

• Diagnostic tests– Urinalysis can be done to check for strands of protein in the urine sample. An abnormal blood pressure might also indicate some problem. In case there is some nephrotic syndrome detected, the doctor might suggest a course of steroids. If the NS is non-responsive to steroids, the doctor might order other diagnostic tests like biopsy, ultrasound and x-ray of the kidney, or nuclear medicine study.
• Kidney function tests– simple blood tests can be done to determine if the kidney is functioning properly. These tests can measure the creatinine level, glomerular filtration rate, cholesterol level, as well as albumin.

Possible treatment methods

Being a chronic disease, CKD has no permanent solution, save for a complete kidney transplant in cases where the kidney is very severely damaged. Apart from that, there are ways through which the onset of the disease can be significantly slowed down, and a relatively normal quality of life can be maintained.

People suffering from CKD might also need to undergo regular dialysis to filter out the waste from their body.

Maintenance for CKD

The maintenance of CKD generally includes multiple dietary restrictions to ensure that the kidney does not have to endure too much pressure. Patients are advised to take extra carbohydrates and fat to increase the calorie intake so as to not feel fatigued.

The protein intake is restrained as filtering the proteins strains the kidney quite a lot. However, it should be kept in mind that if the protein intake is reduced too much, it might affect the growth and development of children.

The water intake is also heavily monitored. Instead of drinking huge amounts of liquid, patients are often encouraged to drink slushies, or suck on ice cubes.

Apart from this, the amount of sodium, potassium, and phosphorous is also limited.

A dietician should always be consulted while preparing a diet plan for a child suffering with CKD.

Apart from dietary restrictions, the doctor might also suggest immunization to help the child stay safe from various external infections.