Renal failure, commonly referred to as kidney failure, occurs when the kidneys experience a decline in their ability to effectively eliminate waste materials from the body. Consequently, this can result in the accumulation of toxic substances and waste products within the bloodstream. Kidney failure can manifest as either acute, characterized by a sudden onset, or chronic, which gradually develops over time and tends to be long-lasting or permanent.
Acute and chronic renal failure
Acute kidney failure can arise from various causes such as bacterial infection, injury, shock, heart failure, poisoning, or drug overdose. The treatment approach involves addressing the underlying issue that caused the kidney injury and, if necessary, considering dialysis.
Chronic kidney failure is a progressive decline in kidney function. In children and adolescents, it can be caused by persistent acute kidney failure, birth defects, chronic kidney diseases, or chronic, severe hypertension. Early diagnosis of chronic kidney failure allows for effective treatment. Typically, the objective of treatment is to slow down the deterioration of kidney function through the use of medication, blood pressure management, and dietary adjustments. In certain cases, a kidney transplant may become necessary.
Causes of renal failure in children
Kidney failure in adults is frequently attributed to diabetes and high blood pressure. However, the causes of kidney failure in children can arise from various causes:
- Certain genetic disorders, such as polycystic kidney disease and Alport syndrome, can be inherited and pose a threat to the kidneys.
- Birth defects affecting the kidneys or urinary tract can hinder their proper functioning.
- Glomerular diseases like glomerulonephritis can cause damage to the kidney filters (glomeruli).
Signs of kidney failure in children
A child may not exhibit any symptoms of kidney failure until their kidney function declines to less than 15 percent.
Common signs of kidney failure include:
- Decreased urine output
- Fluid retention
- Decreased energy
- Paleness caused by anemia (low level of red blood cells)
Additional, non-specific symptoms include:
- Poor appetite
- Stunted growth
- Vomiting
- Headaches
- Urinary tract infections
- Incontinence (inability to hold urine)
- Fever
- Rash
- Bloody diarrhea
- Abdominal mass (lump in the abdomen)
Diagnosis of renal failure
Your child's healthcare provider may request the following diagnostic tests in addition to conducting a physical examination and reviewing their complete medical history:
Blood tests: Blood tests are essential for assessing blood cell counts, electrolyte levels, and kidney function.
Urine tests: Urine analysis is used to identify irregularities (such as an excessive amount of red blood cells) that could indicate inflammation or irritation in the urinary system. Additionally, urine tests can identify an abundance of white blood cells, which is predominantly linked to bladder and kidney infections.
Chest X-ray: A chest X-ray is a diagnostic procedure that utilizes electromagnetic energy beams to generate images of internal tissues, bones, and organs onto film.
Bone scan: A bone scan is a nuclear imaging technique used to assess degenerative and/or arthritic alterations in the joints, identify bone diseases and tumors, and ascertain the underlying cause of bone pain or inflammation.
Renal ultrasound: Renal ultrasound, also known as sonography, is a non-invasive procedure that involves passing a transducer over the kidney to generate sound waves. These sound waves bounce off the kidney and create a visual representation of the organ on a video screen. This test is commonly performed to assess the size and shape of the kidney, as well as to identify any masses, kidney stones, cysts, obstructions, or abnormalities present.
Electrocardiogram (ECG or EKG): An electrocardiogram is a diagnostic test that records the electrical signals produced by the heart. It is capable of identifying irregular heart rhythms (arrhythmias or dysrhythmias) and detecting any potential damage to the heart muscle.
Renal biopsy: Renal biopsy is a medical procedure that involves extracting tissue samples from the patient’s kidney, either through the use of a needle or during surgery. These samples are subsequently examined under a microscope.
Treatment of renal failure in children
Different types of renal failure in children may require either short-term or long-term treatment, which may involve dialysis and/or kidney transplant. Treatment options vary depending on the specific type of renal failure.
Medications: Your child might require treatment to address the underlying cause of their kidney failure. This could involve taking medications that help suppress their immune system.
Dialysis: Dialysis is a process that artificially filters your child's blood, removing waste, and extra water until their kidneys regain their normal function. There are two types of dialysis:
Hemodialysis involves a machine that pumps your child's blood out, passes it through a filter, and returns it to their body. They will have to undergo this treatment a few times every week.
Peritoneal dialysis uses a special solution that is inserted into the abdomen of your child to absorb waste and excess fluid. Subsequently, the used solution is removed from your child's abdomen.
Kidney transplant: Kidney transplantation is a procedure that involves surgically implanting a healthy kidney into your child's body. This kidney can either be obtained from a living donor or from someone who has recently passed away (deceased donor).
Following the transplant, it is essential for your child to adhere to a strict medication regimen and undergo regular check-ups to ensure the optimal functioning of the newly transplanted kidney.
Treating complications
In addition to providing care for your child, the medical team will also closely monitor any complications that may arise from renal failure and promptly intervene with necessary treatment. This multidisciplinary care team, comprising pediatric nephrologists, pediatricians, pediatric urologists, transplant surgeons, and other specialists, will work together to effectively manage and address any potential complications that may arise.
Anemia: Insufficient production of the hormone erythropoietin, which aids in the formation of red blood cells, can occur in kidneys that have been damaged. In order to compensate for this deficiency, your child may require injections of erythropoietin.
Growth problems: The kidneys play a vital role in maintaining the balance of phosphorus and calcium levels in your child's body, thereby influencing bone growth. To improve bone health and facilitate growth, medication or injections can be prescribed.
Weakened immune system: Accumulation of waste in your child's bloodstream can significantly increase their susceptibility to illnesses. However, by ensuring that your child receives appropriate vaccinations, you can effectively safeguard them against specific infections.
Learning or developmental difficulties: Waste present in the bloodstream can hinder the efficiency of nerve and brain activities. Consequently, your child may encounter difficulties in focusing or acquiring certain skills. However, there are various approaches such as behavioral, educational, and physical therapies that can aid in addressing learning or developmental delays.
In summary, pediatric kidney failure presents a significant health challenge that requires comprehensive medical intervention, continuous monitoring, and the implementation of a supportive care framework to improve the quality of life for children affected by this condition.
NU Hospitals in Bangalore, India, is a distinguished healthcare institution that specializes in nephrology and urology. It offers an exceptional combination of state-of-the-art facilities and advanced technology to provide outstanding medical services to children suffering from kidney failure.
