Different conditions of Pediatric kidney disease and its types

Pediatric kidney disease is a deteriorating condition that affects the kidneys in children. There are some common types of pediatric kidney disease which includes congenital anomalies of the kidneys and urinary tract, nephrotic syndrome, glomerulonephritis, pyelonephritis, and varying sized kidney stones along with other associated renal complications.

The most common type of pediatric kidney disease is congenital anomalies of kidneys and including urinary tract, and they can often go from mild to severe. These anomalies affect the structures as well as functions of the kidneys, leading to various problems like urine blockage, kidney damage, and high blood pressure.

Nephrotic syndrome is also another condition characterized by presence of high levels of protein in the urine and low levels of protein in the blood, and presence of edema in various parts of the body, such as the face, legs, ankles, knees and abdomen. This is done by damage to the filtering units (glomeruli) of the kidneys, making proteins leak in the urine.

Glomerulonephritis affects the glomeruli(filtering units ), that filter waste products from the blood. It may be caused by a number of factors, such as infections, autoimmune disorders, and certain medications with their side effects .

Pyelonephritis caused by bacteria infects the kidneys, causing fever, chills, back pain, and frequent urination. It is more commonly seen in girls than boys, and can lead to kidney damage if left untreated over time.

Kidney stones form in the kidneys or the urinary tract, and that can cause pain and difficulty urinating in the person. Children with certain medical conditions, such as cystinuria, are more likely to develop kidney stones at a very early age.

How likely is pediatric kidney disease to affect children(below 15 years)?

Pediatric kidney disease is not much common in children, but it can still affect a specific number of them. The incidence and prevalence of pediatric kidney disease fluctuates depending upon the specified type of conditions in children.

Congenital anomalies of the kidneys and urinary tract are the most habitual type of pediatric kidney disease, and they are eventually approximated to happen in about 1 in 500 births. However, many of these anomalies are quite mild and do not cause any complications at an early age.

Nephrotic syndrome influences about 2-7 children per 1 lakh children, with the highest incidence in children between the ages of 1-5 years old.

Glomerulonephritis is slightest than nephrotic syndrome, with an estimated prevalence of 1-3 per 100,000 children per year.

Pyelonephritis is more ordinary in girls than boys, and its incidence prevails depending on the age groups. In infants, the incidence is approximately estimated to be about 1-2 per 1,000 births, while in older children, the incidence is low.

Kidney stones are quite infrequent in children, but their incidence appears to be increasing with the overall prevalence of kidney stones in children to be less than 1%, but it may be higher in certain populations.

What are the symptoms of pediatric kidney disease?

The noticeable symptoms of pediatric kidney disease can extend depending on the specific type of condition, however some common ones includes:

Pain in abdomen region or groin region: Children with kidney disease may experience abdominal discomfort in the lower back or on the sides.

Blood present with urine: Blood in the urine (hematuria) is a usual sign of kidney disease, and it may be detected only through laboratory tests and different imaging tests.

Edema/oedema: Swelling (edema) in various parts of the body, such as the face, legs, and lower abdomen, difficult walking and pain in ankles ,knees, are some habitual symptoms of nephrotic problems and other types of kidney disease.

Fatigue: Children with kidney disease feel lethargic and exhausted, which is due to anemia or buildup of toxins in the body and even affecting them physiologically .

 Frequent Fever and chills: Children with pyelonephritis or kidney infections may experience fever, chills, and noted symptoms of infection due to invading of bacteria in the body.

High blood pressure: High blood pressure (hypertension) is a sign of kidney disease, and it can lead to long-term complications if left untreated and even cause cardiovascular problems.

Poor growth of body: Children with kidney disease have poor growth or delayed development, which is due to malnutrition, anemia, and toxins.

Urinary tract infections: Children with kidney disease are more prone and frequent to urinary tract infections, causing pain, burning, and frequent urination due to bacteria.

What causes kidney disease to develop in children?

Kidney disease in children can have various causes and complications. Some factors that can evoke the development of kidney disease in children include:

Congenital abnormalities: Children can be born with structural abnormalities of the kidneys or urinary tract infections have increased risks of kidney problems. Conditions such as renal dysplasia, polycystic kidney disease, vesicoureteral reflux, and obstructive uropathy are examples of some congenital abnormalities that can lead to kidney disease in the person.

Bacterial Infections in body: Some infections can lead to progressing kidney disease such as urinary tract infections (UTIs), pyelonephritis and viral infections like hepatitis B and C.

Genetic conditions: In children kidney disease can be caused by genetic factors such as Alport syndrome, autosomal recessive polycystic kidney disease (ARPKD), and nephrotic syndrome leading towards chronic kidney disease.
Glomerulonephritis: It is an inflammation of the glomeruli that tiny filters within the kidneys caused due to infections, autoimmune disorders, or other conditions. Glomerulonephritis impairs the kidney function progressively.

Systemic diseases: some systemic diseases can affect the kidneys in children, these include systemic lupus erythematosus (SLE), diabetes, Henoch-Schönlein purpura, and HUS (hemolytic uremic syndrome).

Excess Medications and toxins: Certain medications and its exposure can lead to toxins that can cause kidney damage in children. The Nonsteroidal anti-inflammatory drugs (NSAIDs)  , some antibiotics, and certain chemicals show harmful effects on the kidneys due to their side effects.

Trauma or injury : Physical injury or trauma to the kidneys can cause kidney damage and progressing  kidney disease.

How is diagnosis of kidney disease in children done? 

The diagnosis of kidney disease in children typically involves a package of medical history review, physical examination, laboratory tests, and imaging studies. Here are some way show diagnosis is done:-

Medical history along with physical examination: the child’s symptoms, family history of kidney disease, certain genetic factors, past medical problems and any relevant medical conditions are required to know the medical history of the patient. Some physical examinations are conducted to assess signs of kidney disease, such as high blood pressure, swelling (edema), or abnormal urine appearance, pain in the abdomen region .

Urine test: Urine tests help to detect abnormalities. It reveals the presence of blood, protein, or infection in the urine. Typically, a 24-hour urine collection is performed to measure protein levels and assess kidney function more accurately.

Blood test: It provides major information about kidney function, electrolyte levels, waste product accumulation, and overall health of kidneys. Repetitive blood tests include serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and electrolyte levels (sodium, potassium).

 Certain Imaging studies: Imaging tests help in visualizing the kidneys and identify any structural abnormalities or blockages. Ultrasound is mostly used as an initial imaging modality in children for its safety, non-invasiveness, and being radiation less. Others include CT scan or MRI may be used in specific cases.

The Biopsy: In certain cases, a kidney biopsy is also performed to obtain a small sample of kidney tissue for detailed examination under minute evaluation. This helps in identifying the specific cause and severity of kidney disease.

How is pediatric nephropathy treated?

The treatment of pediatric kidney disease depends on its underlying cause and the severity of the condition. Some common approaches practiced in managing kidney disease in children:

Prescribed Medications: Medications are prescribed to treat the underlying conditions, manage symptoms, and slow the progression of kidney disease. The specific medications depends on the type of kidney disease and the individual needs of the child and these  include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) implemented to control blood pressure and reduce proteinuria, immunosuppressive drugs for certain autoimmune kidney diseases, and diuretics to manage fluid retention.

Dietary modifications/changes: A renal diet maintenance is must which involves limiting certain nutrients such as sodium, potassium, and phosphorus. This reduces the workload on the kidneys and maintains electrolyte balance. In some cases a personalized meal plan based on the child’s specific nutritional needs is required.

Management of fluids in the body: optimum hydration is important for kidney function to work well. A guidance on fluid intake is required to ensure proper hydration while considering any restrictions based on the child’s specific condition.

Dialysis: In cases of advanced kidney disease or even kidney failure, dialysis may be considered. It removes waste products and excess fluids from the body to improve kidney functioning. Considering there are two main alternatives of dialysis: one ,hemodialysis and the other peritoneal dialysis. The choice of dialysis modality actually depends on factors such as the child’s age, medical condition, and preferences.

Kidney transplantation: children with end-stage kidney disease are left with  kidney transplant as an only option. This is a surgical process to replace diseased kidney with a healthy kidney from a compatible donor, either living or deceased. It offers the best long-term outcome for many children.

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