Chronic renal failure is a serious condition that can be encountered in all age groups, including children. Studies demonstrate that 3 of every one million children have chronic renal failure. Our kidneys undertake many functions to keep our body healthy. Kidneys filter and remove harmful substances from the blood. Besides, our kidneys maintain homeostasis of fluid and salt in our body, regulate our blood pressure, help blood production and even ensure that our bones are strong and durable by regulating the bone development. Kidneys are also responsible for homeostasis of calcium and phosphorus in our body. “Kidney failure” means that kidneys cannot fulfil those functions and it causes dysfunction of many other organ systems along with kidneys.
What are causes of chronic renal failure in children?
Many factors may hinder proper functioning of kidneys. The most important one is congenital disorders. “Vesicoureteral reflux” is the most common one among those disorders. In vesicoureteral reflux, urine flows from the bladder back up to the kidneys. This condition is accompanied by recurrent urinary tract infections and causes wounds in the kidneys as well as dysfunctions in the long term. Other congenital anomalies are the underdevelopment of kidneys or urinary bladder in the womb and occlusions in urinary tracts or canals inside the kidneys. Moreover, some genetic disorders (the disorders that can be inherited by parents to their children) are also important underlying causes of dysfunction. Polycystic kidney disease or Alport Syndrome is a good example for them. Nephritis is also an important etiology for the renal failure. The renal disease, called “nephritis”, has various types and some of these can lead to renal failure. In addition, certain systemic diseases, such as lupus or diabetes, can also cause renal failure. These conditions are not directly linked to kidneys, but they can damage various body parts and the kidneys.
What are symptoms of chronic renal failure in children?
Chronic renal failure is a very insidious condition and it may stay asymptomatic especially at early ages. First, fatigue develops and the condition is mostly skipped at this stage. Hypertension, swollen eyelids and legs, bone aches (more remarkably in legs), osseous deformities in legs and decreased output of urine are likely in advanced stages. If the condition progresses severely, patients can suffer from seizures or comas, develop pulmonary or cardiac problems or suddenly pass away.
Does chronic renal failure affect development of the child?
Kidneys are so important organs of body that their dysfunction leads to catastrophe in all body systems. Renal dysfunction results in improper functioning of almost all organs. Since growth and development continue especially in children, renal failure leads to very serious damages. Growth, development and sexual development stages retard and their learning capacities decrease. Children cannot gain weight and eat a healthy diet due to requirement of special diets and lack of appetite. Kidney failure is also associated with introversion and depression.
What are treatment options for chronic kidney failure in children? Is there a medication treatment?
Doctors have many options to use for treatment of kidney diseases, which are:
- Supportive medication treatment
- Healthy and balanced diet
- Treatments prescribed to maintain development and growth
- Dialysis
- Transplanta
Unfortunately, chronic kidney failure cannot be cured with medicines. The medications are used to support functions of kidney and partially restore the lost functions.
What is the proper diet for children with chronic kidney failure?
Nutrition is extremely important for children with chronic kidney failure. A child should ingest adequate amount of certain nutrients for growth and development. On the other hand, diet should be restricted, as toxic materials will accumulate in the body due to renal dysfunction. The process is like walking on eggs. A precise balance is required. The patients have to pay attention to what they eat, while they receive dialysis.
Certain foods should especially be restricted, such as:
- Oral fluids
- Salty food
- Foods rich in phosphorus and potassium
How does dialysis work and can children receive dialysis?
Organ transplant is the definitive treatment for children with chronic kidney failure, but they may need to go on dialysis at certain intervals until an organ is found. This device is somewhat like an artificial kidney and it filters the blood. It is absolutely safe for children. Sixty dialysis patients have been followed up at our department to date. Currently, we have 10 hemodialysis patients and 20 peritoneal dialysis patients. There are two different methods: Hemodialysis and peritoneal dialysis. Healthcare staff will decide on the best dialysis technique for each child.
Peritoneal dialysis is carried out in two ways: CAPD (Continuous Ambulatory Peritoneal Dialysis) and APD (Automated Peritoneal Dialysis). Both methods are successfully carried out at our center; patients are placed on a special education program and next, the device is supplied to patients to have the child go on dialysis at home. Peritoneal dialysis at home settings is a much better option for maintaining the school life and a more balanced diet.
Hemodialysis implies filtering the blood outside of the body with a device (artificial kidney) and pumping the filtered blood back to the body. It is performed at dialysis units of hospitals under normal circumstances. It should be done 2 to 3 times per week, depending on health status of the patient. Each session lasts 4 to 5 hours. A minor surgical procedure is required for hemodialysis. The procedure is carried out to construct a connection between an artery and a vein in order to facilitate and quicken hemodialysis. Hemodialysis filters and removes toxic materials quickly and successfully. But it should necessarily be done by specialized nurses and doctors. This requires a higher precision and expertise in case of children.