How to detect Kidney disease in children? Early signs parents must not ignore!

Kidneys are amazing yet complicated organs. Their main function is to remove toxins and excess water from the blood, help regulate blood pressure, produce red blood cells, and keep our bones healthy. Kidneys are affected by various disorders which can be sudden in onset (Acute Kidney Injury/Disease) or damage that occurs over years causing permanent kidney dysfunction (Chronic Kidney Disease). Kidney disease is seen in all age groups, the young and the older population. The causes differ in each group.

Childhood Kidney Disease

Kidney disease is not uncommon in children. The most common diseases in children are present at birth and often are genetic. In addition, kidney disease can present in early childhood too. Some of the common kidney diseases are caused by:

Birth defects and Atypical development of Urinary Tract: A birth defect is when part of the baby’s body does not develop normally in the mother’s body or womb. E.g.: Kidney agenesis – baby without a kidney or both, Kidney dysplasia/hypoplasia, Double or duplication of Kidney, horseshoe-shaped Kidneys.

Posterior Urethral Value Obstruction: Exclusively seen in boys wherein there is narrowing or blockage of the urethra by an abnormal membrane, this can be diagnosed early in life and treated by a surgical procedure.

Hereditary Kidney Disease:

Polycystic kidney disease (PKD) is one of the common conditions with multiple fluid-filled sacs all over both kidneys diagnosed before or after birth. It remains mostly asymptomatic throughout life or can present with Urinary Infection, Blood pressure, or Kidney failure later in life.

Infection: Urinary Tract infection is the most common disease of the urinary system in children. Recurrent UTIs and VUR (backflow of urine from the bladder into the kidneys) are the common causes of scarring of the kidneys, Blood pressure, protein loss, and kidney failure later in life. Post-streptococcal Infection is an infection that initially develops in the throat or skin, giving rise to infection in the kidneys, causing blood in the urine, excess fluid accumulation in the body, blood pressure, and sometimes kidney insufficiency. It has become less common due to better living conditions and awareness.

Nephrotic Syndrome: It is a common disorder in children that causes leakage of proteins in the urine when the filtering kidney unit is damaged. Children present with swelling of the whole body. It is a disease that can be treated with medications in the majority of the cases.

Renal Tubular Acidosis: It is a defect in the kidney impairing the acid removal by the body which can give rise to stunted growth of the child. This disorder is easily treatable with simple medicines if identified early.

Early Signs a Parent Must Not Ignore:

Some of the common symptoms parents should pay attention to in a child are:

• Fever, swelling in the legs, feet & face
• Increased or decreased urine volume & nighttime bed wetting.
• Foamy Urine
• Cola-coloured & pink urine caused by blood in urine.
• Poor growth & development of child (stunted growth)
• Rashes/high blood pressure/weakness/shortness of breath

Special Features to look for are as follows

• Any of the symptoms mentioned above that are unremitting
• Straining & screaming during the passing of urine
• Poor force or stream of urine in a boy
• Excessive urination or passing very little urine
• Bed-wetting after the age of 5-6 years
• Child not growing well/short stature
• Child having recurrent urine infection
• Passing foamy or red-coloured urine
• Early childhood hearing or vision defect
• Any unusual bony swelling or mass in the abdomen
• If one or more family members have kidney issues
• Unexplainable low haemoglobin count

Diagnosis generally begins with a physical examination of the child with the help of parents followed by an overall history and health of the child. Nomograms can be suggested to help assess the growth of the child. Other investigations include lab tests like urine and blood, and imaging studies like ultrasound, CT, or nuclear scans. Genetic Testing (wherever necessary), kidney biopsy, etc. are also necessary in certain situations to detect kidney disease in children. Regular follow-up with a Child specialist/Nephrologist is crucial along with avoidance of alternative forms of medicines especially when a renal ailment is detected or recognized.

 

(This article is authored by Dr. G K Prakash, Consultant – Nephrologist & Transplant Physician, Manipal Hospital Malleshwaram & Millers Road.)