Kidney Disease

Evidence 

https://www.bmj.com/content/365/bmj.l1346 

Casey Crump, Jan Sundquist, Marilyn A Winkleby, emerita, Kristina Sundquist.

Preterm birth (before 37 weeks of pregnancy) interrupts kidney development and maturity during late-stage pregnancy, resulting in fewer nephrons forming (filters that remove waste and toxins from the body). 

Other Evidence links: 

Long-term consequences of prematurity | Cleveland Clinic Journal of Medicine 

Prematurity and Future Kidney Health: The Growing Risk of Chronic Kidney Disease - PMC 

Education 

Your kidneys are a vital part of your baby's body. The kidney’s main task is to clean the blood and filter waste out through their urine. When the kidneys aren't functioning as they should, waste gradually builds up in the body. 

The kidneys also produce three important hormones: 

• erythropoietin, which stimulates the bone marrow to make red blood cells. 

• renin, which helps regulate blood pressure; and 

• the active form of vitamin D, which helps control the calcium balance in the body and maintain healthy bones.

Normally the kidneys are formed prior to birth, with no new nephrons (functional units of the kidney) made after birth. However, in premature babies this formation continues to occur after birth, making the kidneys vulnerable to impaired development and injury and potential kidney disease in later life. 

Babies who are born prematurely often have kidney problems shortly after birth, called nephropathy (kidney disease) of prematurity. In most cases, the baby’s kidneys usually mature quickly after birth. 

However, it’s common for premature babies to have problems balancing body fluids, salts, and wastes in the first four or five days of life. During this time, a premature baby’s kidneys may have trouble: 

• Filtering wastes from the blood, which keeps substances like potassium, urea, and creatinine in proper balance. 

• Concentrating urine or getting rid of wastes from the body without excreting excess fluids. 

• Producing urine, which can be a problem if the kidneys were damaged during delivery or if the baby was without oxygen for a prolonged period of time.

Paediatric nephrologists work closely with paediatricians, neonatologists, and other specialists to give your baby the best care possible. 

What is chronic kidney disease (CKD)? 

Kidney disease is a condition in which the kidneys are damaged and can’t filter the blood the way they should. This damage can cause wastes and fluid to build up in the body.  

Chronic kidney disease involves a deterioration of kidney function over time, usually months to years. It can result from being born premature, being born with birth defects or if your child was born with an infection. 

If diagnosed early, chronic kidney disease treatment may slow the progression of the disease, ease symptoms, and manage complications.  

CKD may gradually lead to kidney failure. Kidney failure means a person will most likely need a kidney transplant or dialysis soon to stay healthier longer. 

What are the complications of kidney disease in children? 

 Complications of kidney disease in children may include 

• anaemia 

• cardiovascular disease, or heart disease 

• electrolyte imbalances in the blood, especially potassium 

• growth problems, especially shorter-than-average height 

• high blood pressure, or hypertension 

• infection 

• metabolic acidosis 

• mineral and bone disorder 

• cognitive issues 

• urinary incontinence

Kidney disease can also affect children’s lives in other ways, causing problems related to behaviour, relationships, and self-esteem. Children with CKD may have difficulty concentrating and learning and may develop language and motor skills more slowly than their peers.  

What are the symptoms of kidney disease in children? 

Children in early stages of kidney disease may have few or no symptoms. As kidney disease gets worse, symptoms may include. 

• swelling in the feet, legs, hands, or face, called oedema. 

• increased or decreased urine output. Some children may have to urinate more often and may wet the bed at night. 

• foamy urine due to too much protein in the urine, called proteinuria. 

• pink or cola-coloured urine caused by blood in the urine, called haematuria.

Other symptoms may include. 

• decreased appetite 

• feeling tired 

• fever 

• high blood pressure 

• itchy skin 

• nausea or vomiting 

• shortness of breath 

• trouble concentrating 

• weakness 

• weight loss 

• stunted growth

Symptoms can vary from child to child, depending on the cause of the kidney disease. 

Childhood Kidney Diseases 

The most common kidney diseases in children are present at birth. They include: 

Posterior urethral valve obstruction: This narrowing or obstruction of the urethra affects only boys. It can be diagnosed before the baby is born or just after and is treated with surgery. 

Fetal hydronephrosis: This enlargement of one or both of the kidneys is caused by either an obstruction in the developing urinary tract or a condition called vesicoureteral reflux (VUR) in which urine abnormally flows backward (or refluxes) from the bladder into the ureters. Fetal hydronephrosis is usually diagnosed before the child is born and treatment varies widely. In some cases, the condition only requires ongoing monitoring; in others, surgery must be done to clear the obstruction from the urinary tract. 

Polycystic kidney disease (PKD): This is a condition in which many fluid-filled cysts develop in both kidneys. The cysts can multiply so much and grow so large that they lead to kidney failure. Most forms of PKD are inherited. Doctors can diagnose it before or after the child is born. In some cases, there are no symptoms; in others, PKD can lead to UTIs, kidney stones, and high blood pressure. Treatment for PKD varies — some cases can be managed with dietary changes; others require a kidney transplant or dialysis. 

Multicystic kidney disease (MKD): This is when large cysts develop in a kidney that hasn't developed properly, eventually causing it to stop working. (While PKD always affects both kidneys, MKD usually affects just one kidney.) Fortunately, the unaffected kidney takes over and most people with MKD will have normal kidney function. MKD usually is diagnosed by prenatal ultrasound before birth. Doctors manage it by monitoring blood pressure and screening for UTIs when needed. Very rarely, surgical removal of the kidney might be necessary. 

Empowerment 

Health Care Professionals specialising in kidney health are now advising children who were born prematurely as preventive actions to have kidney function checked across their lifetime.  

Yearly, urinalysis and blood pressure check and blood work targeting kidney function is recommended and to also be proactive if problems arise.  

Useful Links  

Special thanks to Kidney Health Australia for content sharing and providing support for families.  

Kidney Health Australia 

https://kidney.org.au/ 

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