Overview of Kidney Diseases in Children


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Overview of Kidney Diseases in Children

  1. 1. Overview of Kidney Diseases in Children What are the kidneys, and What are the causes of kidney what do they do? The kidneys are two bean-shaped organs Treatment Methods for failure in children? Kidney failure may be acute or chronic. located near the middle of the back, just Acute diseases develop quickly and can be below the rib cage. When blood flows through the kidneys, waste products and Kidney Failure in Children very serious. Although an acute disease may have long-lasting consequences, it extra water are removed from the blood usually lasts for only a short time and then K idneys play an important part in and sent to the bladder as urine. The kid- a child’s growth and health. neys also regulate blood pressure, balance They chemicals like sodium and potassium, and Problems Specific to Children goes away once the underlying cause has been treated. Chronichas kidney however, Everyone who diseases, failure, adults and children alike, will experience med- do not go away and tend to get worse over ical complications, which may include make hormones to help bones grow and water time. When the kidneysinability to concen- remove wastes and extra from the blood extreme fatigue, stop working, keep the blood healthy by making new red doctors use a treatment called dialysis to trate, weak bones, nerve damage, blood cells. regulate blood pressure remove waste products sleep extra water depression, and and problems. Addi- balance chemicals like sodium and patients with chronic children can include from tional problems for kidney failure. Who is at risk? potassium In the general population, slightly moresignals bone make a hormone that Acute Kidney Diseases marrow to make red blood cells Acute kidney disease may result from an than 30 people in every 100,000 develop kidney failure each year. a hormone to help bones injury or from poisoning. Any injury that make In the pediatric grow and keep them strong population—age 19 and under—the annual results in loss of blood may reduce kidney rate is only 1 or 2Kidney failure can lead directly to function temporarily, but once the blood new cases in every more 100,000 children.health problems, like swelling of the In other words, adults supply is replenished, the kidneys usually are about 20 times more likely to develop growth fail- to normal. Other Kidneys of acute body, bone deformities, and return kinds ure. A successful kidney transplant can disease in children are kidney kidney failure than children. The risk give a child with chronic kidney failure increases steadily the best chance to grow normally andHemolytic uremic syndrome. This rare with age. Ureters disease affects mostly children under 10 lead a full, active life. Dialysis can help African Americans in their late teens are a child to survive an acute episode of years of age and can result in kidney three times more likely than Caucasians kidney failure or to stay healthy until a in the same age group to develop kidneyavailable. failure. Eating foods contaminated by donated kidney becomes failure. Diseases that damage the tiny bacteria leads to an infection in the blood vessels in the kidney are alsoamore with kidney Families caring for child digestive system, which in the first disease often need help—not just from stages causes vomiting and diarrhea. common in children of color.nurses, but from a whole doctors and Moreover, Bladder boys are nearly twice as likely as girls When these symptoms subside, the child team of pediatric specialists, including to develop kidneydietitians, social workers, and family is still listless and pale. Poisons pro- failure from birth defects, polycysticcounselors. Learning about treatments kidney disease, or duced by the bacteria can damage the other hereditary diseases. disease and getting to know for kidney kidneys, causing acute kidney failure. The kidneys remove wastes and extra water from the the entire team can make life easier for Children with hemolyticflows from the kidneys to blood to form urine. Urine uremic syn- your child and your entire family. dromethe bladder through the ureters. may need blood transfusion or dialysis for a short time. Most children, National Institute of Diabetes Institute of Diabetes and Digestive and Kidney Diseases National and Digestive and Kidney Diseases U.S. Department of Health U.S. Department of Health NATIONAL INSTITUTES OF HEALTH NATIONAL INSTITUTES OF HEALTH and Human Services and Human Services Phone: 800.633.6628 • www.kidneyurology.org
  2. 2. however, return to normal after a few 30 weeks. Only a small percentage of children Ages 15–19 (mostly those who have severe acute kidney 25 disease) will develop chronic kidney disease. Rate per Million Population I Nephrotic syndrome. A child with this syn- 20 drome will urinate less often, so the water left in the body causes swelling around the Ages 10–14 eyes, legs, and belly. The small amount of 15 urine the body makes contains high levels of protein. Healthy kidneys keep protein in 10 Ages 0–4 the blood, but damaged kidneys let it leak Ages 5–9 from the blood into the urine. Nephrotic 5 syndrome can usually be treated with pred- 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 nisone to stop protein leakage, and some- Year times a diuretic is used to help the child urinate and reduce the swelling. Usually, the New cases, by age, per million population, adjusted for gender and child can take smaller and smaller doses of race. prednisone and eventually return to normal Source: United States Renal Data System. 2005 Annual Data Report: with no lasting kidney damage. This tempo- Atlas of End-Stage Renal Disease in the United States. 2005. rary condition is called minimal change dis- ease. Relapses are common but usually Alport syndrome, the defective gene that respond to prednisone treatment. causes kidney disease may also cause hearing or vision loss. Chronic Kidney Diseases I Glomerular diseases. Some diseases attack the Unfortunately, the conditions that lead to chronic individual filtering units in the kidney. When kidney failure in children cannot be easily fixed. damaged, these filters—which are called Often, the condition will develop so slowly that it glomeruli—leak blood and protein into the goes unnoticed until the kidneys have been per- urine. If the damage to the glomeruli is severe, manently damaged. Treatment may slow down kidney failure may develop. the progression of some diseases, but in many cases the child will eventually need dialysis or I Systemic diseases. Diabetes and lupus can transplantation. affect many parts of the body, including the kidneys in some people. In lupus, the immune I Birth defects. Some babies are born without system becomes overactive and attacks the kidneys or with abnormally formed kidneys. body’s own tissues. Diabetes leads to high lev- The kidney abnormality is sometimes part of a els of blood glucose that damage the glomeruli. syndrome that affects many parts of the body. Diabetes is the leading cause of kidney failure I Blocked urine flow and reflux. If blockage in adults. In children, however, diabetes is low develops between the kidneys and the opening on the list of causes because it usually takes where urine leaves the body, the urine can back many years of high blood glucose for the kid- up and damage the kidney. ney disease of diabetes to develop. However, an increasing number of children have type 2 I Hereditary diseases. In polycystic kidney dis- diabetes, which is usually associated with ease (PKD), children inherit defective genes adults. As a result, we may see more children that cause the kidneys to develop many cysts, with chronic kidney failure caused by diabetes sacs of fluid that replace healthy tissue and in the future. keep the kidneys from doing their job. In 2
  3. 3. From birth to age 4 years, birth defects and Transplantation hereditary diseases are by far the leading causes Transplantation provides the closest thing to a of kidney failure. Between ages 5 and 14 years, cure for kidney failure. In this procedure, a sur- hereditary diseases continue to be the most com- geon places a healthy kidney in the child’s body. mon causes, followed closely by glomerular dis- The kidney may come either from a living donor eases. In the 15- to 19-year-old age group, or from someone who has just died. glomerular diseases are the leading cause, and hereditary diseases become rarer. I Living donor. Most people can donate a kidney without hurting their health. Many children receive a kidney from one of their What are the treatments parents, but the donor does not have to be a for kidney failure? family member. A child whose kidneys fail completely must I Deceased donor. If no living donors are avail- receive treatment to replace the work the kidneys able, a child may be placed on a waiting list to do. The two types of treatment are dialysis and receive a kidney from someone who has just transplantation. died. The United Network for Organ Sharing (UNOS) maintains a computerized system for Dialysis matching kidneys with appropriate recipients. Dialysis is a way to remove the waste products People who have transplants must take drugs to and extra water from the blood of patients with keep the body’s immune system from rejecting the kidney failure. The two main types of dialysis are new organ. These immunosuppressive drugs can peritoneal dialysis and hemodialysis. help maintain good function in the transplanted I Peritoneal dialysis. This method uses the lining kidney for many years. However, they may have of the child’s abdominal cavity, the peritoneum, some undesirable side effects such as making a as a filter. A catheter placed in the child’s belly child vulnerable to infections. is used to pour a solution containing dextrose For more information about dialysis and trans- (a sugar) into the abdominal cavity. While the plantation, see the National Institute of Diabetes solution is there, it pulls wastes and extra fluid and Digestive and Kidney Diseases (NIDDK) fact from the blood. Later, the solution is drained sheet Treatment Methods for Kidney Failure in from the belly, along with the wastes and extra Children. fluid. The cavity is then refilled, and the clean- ing process continues. Peritoneal dialysis can be performed in the home, usually while the Hope Through Research child sleeps, without a health professional pres- Through its Division of Kidney, Urologic, and ent. You and your child will receive extensive Hematologic Diseases, the NIDDK supports sev- training before you start home treatments. eral programs and studies devoted to improving treatment for patients with progressive kidney I Hemodialysis. This method uses a machine disease and kidney failure. The NIDDK main- that carries the child’s blood through a tube to tains the Pediatric Nephrology Program, which a dialyzer, a canister that contains thousands of supports research into the causes, treatment, and fibers that filter out the wastes and extra fluid. prevention of kidney diseases in children, includ- The cleaned blood is then returned to the child ing congenital malformations of the urinary tract, through a different tube. Hemodialysis is usu- polycystic disease, primary glomerular disease, ally performed in a clinic under the supervision and postinfectious glomerulonephritis. of a nurse and kidney specialist. It is generally required three times a week for about 3 to 4 hours each time. 3
  4. 4. For More Information National Kidney and Urologic For More Information American Kidney Fund American Society of Pediatric Nephrology Diseases Information Clearinghouse 6110 Executive Boulevard Northwestern University A Suite 1010 3 Information Way Feinberg School of Medicine Bethesda, MD 20892–3580 Rockville, W140 Pediatrics MD 20852 Phone: 1–800–891–5390 Phone: 1–800–638–8299 or 303 East Chicago Avenue Fax: 703–738–4929 301–881–3052 Chicago, IL 60611–3008 Email: nkudic@info.niddk.nih.gov Email: helpline@akfinc.org Phone: 312–503–4000 Internet: www.kidney.niddk.nih.gov Internet: www.kidneyfund.org Fax: 312–503–1181Pediatric Nephrology American Kidney Fund The National Kidney and Urologic Diseases American Society of Email: aspn@northwestern.edu 6110 Executive Boulevard Northwestern University American Society of Pediatric Nephrology Information Clearinghouse (NKUDIC) is a Internet: School of Medicine Feinberg www.aspneph.com Suite 1010 service of the National Institute of Diabetes Northwestern University and Digestive and Kidney Diseases (NIDDK). Feinberg School 20852 Rockville, W140of Medicine Pediatrics MD The NIDDK is part of the National Institutes Phone: 1–800–638–8299 or Pediatrics Chicago Avenue 303 East W140 of Health under the U.S. Department of Health 301–881–3052 Chicago, IL 60611–3008 303 East Chicago Avenue and Human Services. Established in 1987, the Email: helpline@akfinc.org Chicago,312–503–4000 Phone: IL 60611–3008 Clearinghouse provides information about dis- Internet: www.kidneyfund.org Fax: 312–503–1181 Phone: 312–503–4000 eases of the kidneys and urologic system to peo- Email: aspn@northwestern.edu ple with kidney and urologic disorders and to Fax: 312–503–1181Pediatric Nephrology American Society of their families, health care professionals, and the Internet: www.aspneph.com Email: aspn@northwestern.edu Northwestern University public. The NKUDIC answers inquiries, devel- Internet: www.aspneph.com F ops and distributes publications, and works closely with professional and patient organi- National Kidney Foundation zations and Government agencies to coordinate 30 East 33rd Street resources about kidney and urologic diseases. New York, NY 10016 Publications produced by the Clearinghouse are Phone: 1–800–622–9010 or carefully reviewed by both NIDDK scientists 212–889–2210 and outside experts. NKUDIC would like to Email: info@kidney.org thank Barbara Fivush, M.D., and Kathy Jabs, Internet: www.kidney.org M.D., of the American Society of Pediatric Nephrology (ASPN), for coordinating the review of this fact sheet by the ASPN’s Clinical Affairs Committee: Tej Mattoo, M.D., William Primack, M.D., Joseph Flynn, M.D., Ira Davis, M.D., Ann Guillott, M.D., Steve Alexander, M.D., Deborah Kees-Folts, M.D., Alicia Neu, M.D., Steve Wassner, M.D., John Brandt, M.D., Manju Chandra, M.D. Frederick Kaskel, M.D., Ph.D., President, ASPN, and Sharon Andreoli, M.D., Secretary–Treasurer, ASPN, also provided comments and coordination. This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate and distribute as many copies as desired. This fact sheet is also available at www.kidney.niddk.nih.gov. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 06–5167 June 2006