Chronic Kidney Disease in Children

June 18, 2021
Janelle Thomas MSN, RN
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Getting sick can feel like a normal part of growing up for any child. But, if your child is constantly sick or if symptoms point to their condition being serious, it can make you feel helpless and worry about their health. Such can be the case with chronic kidney disease. Despite the condition impacting an average of 12.1 million children per year, it can still be terrifying to see your little one dealing with the disease. You want to relieve their symptoms. But, how will the condition impact them long-term?

What is chronic kidney disease?

Your kidneys are bean-shaped organs that filter blood to produce urine, composed of wastes and extra fluid. They work around the clock to filter and remove waste from your body.

Chronic kidney disease (CKD) is a condition that permanently damages the kidneys. Over time, their kidney function decreases — making it more difficult to process food and clear out toxins. CKD is also commonly known as chronic renal disease or chronic kidney failure.

Cause of Chronic Kidney Disease

For most children, birth defects and hereditary diseases are the leading cause of CKD. But, they aren’t the only reasons. Chronic kidney disease can also be the result of:

  • Autoimmune disorders
  • Diabetes
  • Chemotherapy
  • Enlarged prostate in men
  • Glomerulonephritis — an inflammation of the kidneys’ filtering units
  • High blood pressure
  • Infection
  • Interstitial nephritis — an inflammation of the kidneys’ tubules and surrounding structures
  • Kidney Stones
  • Long-term use of certain medications
  • Lupus
  • Nephrotic syndrome
  • Polycystic kidney disease
  • Systemic diseases
  • Trauma
  • Tumors
  • Urinary tract infections, urine blockage, or reflux

Stages of Chronic Kidney Disease

There are five stages for CKD. Each stage is determined by the glomerular filtration rate (GFR). This establishes the level of creatinine in the blood. Healthy kidneys typically filter creatinine from the blood, so the levels should be low. But, as your child’s kidneys fail, their level of creatinine will increase.

Stage 1

Stage 1 has a normal GFR or greater than 90 ml/min. Kidneys are fairly good at filtering, even when they aren’t at 100%. That’s why at this stage, there are typically no symptoms of chronic kidney disease. Most people won’t know they have Stage 1 unless they’re being tested for diabetes or high blood pressure. Since most children don’t experience these issues, it’s likely you won’t know your child is experiencing CKD until a later stage.

Stage 2

Children experiencing Stage 2 will have a glomerular filtration rate of 60-89 ml/min. This demonstrates some mild kidney disease, but is typically similar to Stage 1 in that it’s not noticeable, and there will be no symptoms. As with the previous stage, testing for diabetes or high blood pressure is usually the only way CKD is discovered at this level.

Stage 3

Stage 3 is broken up into two levels: 3A and 3B. Stage 3A has a decrease in GFR to 45-59 mL/min, and Stage 3B shows a decrease in GFR to 30-44 mL/min. At these stages, waste products can build up in the blood (uremia). This can also produce symptoms, such as:

  • Fatigue
  • Fluid retention, swelling (edema) of extremities, and shortness of breath
  • Urination changes — such as foamy, dark orange, brown, tea-colored, or red if it contains blood and urinating more or less than normal
  • Kidney pain felt in their back
  • Sleep problems due to muscle cramps or restless legs

Stage 4

At Stage 4, kidney damage is considered advanced with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. At this stage, your child may need dialysis or a kidney transplant in the near future. In addition to uremia, your child is likely to develop complications of kidney disease — such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease, and other cardiovascular diseases. Common symptoms include:

  • Stage 3 symptoms
  • Nausea and/or vomiting
  • Taste changes — such as a metallic taste in the mouth
  • Bad breath due to buildup in the blood
  • Loss of appetite
  • Difficulty concentrating
  • Nerve problems — such as numbness or tingling in the toes or fingers

Stage 5

The final stage has a glomerular filtration rate (GFR) of 15 ml/min or less. At this stage, your child will develop end-stage renal disease (ESRD), which means that their kidneys no longer function to the body’s needs. Their kidneys will no longer function effectively, and dialysis or a kidney transplant will be needed. Symptoms of Stage 5 CKD include:

  • Loss of appetite
  • Nausea or vomiting
  • Headaches
  • Fatigue
  • Being unable to concentrate
  • Itching
  • Making little or no urine
  • Swelling — especially around the eyes and ankles
  • Muscle cramps
  • Tingling in hands or feet
  • Changes in skin color
  • Increased skin pigmentation

Signs & Symptoms of CKD

Symptoms of chronic kidney disease will depend on what stage your child is at. As your child’s kidney fails, they may develop new signs of kidney damage, or symptoms may worsen. Typically, the most common symptoms of CKD include:

  • Fever
  • Swelling around the eyes, face, feet, and ankles (called edema)
  • Burning or pain during urination
  • Significant increase in the frequency of urination
  • Difficulty in controlling urination — in children who are mature enough to use the toilet
  • Recurrence of nighttime bedwetting — in children who have been dry for several months
  • Blood in the urine
  • High blood pressure, feeling more tired and have less energy
  • Difficulty concentrating
  • Decrease in appetite
  • Muscle cramping at night
  • Dry itchy skin

Diagnosis & Treatment

If kidney disease is suspected, your pediatrician will discuss your child’s medical history as well as your family history, do a physical exam, and order urine tests, blood tests, imaging studies, or a biopsy to help make a diagnosis. The blood test will help determine the GFR — giving you insight into which stage of CKD your child is currently at.

Once diagnosed, treatment options will vary and mostly be targeted at relieving symptoms until your child is at Stage 4 or 5. A nephrologist — a doctor who specializes in treating kidney diseases and kidney failure in children — can help you determine the best treatment plan for your child. Plans may include:

  • Prescriptions for angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics
  • Blood pressure medications
  • Treatment for anemia and growth failure — such as hormones and dietary changes
  • Dialysis
  • Kidney transplantation

Contact Care Options for Kids for Home Health Care in Florida

It can be hard to balance your time between work, home, and caring for a child. That’s why our team of skilled professionals at Care Options for Kids is here to help.

Our home health care services offer support in the comfort of your home. We refer loving and competent nurses to provide customized care for families — from a few hours a day to around-the-clock supervision. Contact us directly to speak with a home health care professional or request a free in-home assessment. Together we can determine the best plan of action to keep your loved ones happy and healthy.

If you or a loved one are considering Pediatric Home Health Care services in Florida, contact the caring staff at Care Options for Kids. Call today at (888) 592-5855.