While not as common or frequently occurring as chronic kidney disease (CKD) in adults, CKD does develop in children. As of 2018, more than 10,000 children and adolescents with end-stage renal disease (ESRD) live in the United States.
Key Points
- CKD affects people of all backgrounds and ages, including children.
- The causes of pediatric CKD include birth defects, nephrotic syndrome, hereditary disease, kidney trauma, and urinary system problems.
- Pediatric CKD has no cure, but many symptoms can be managed with treatment and monitoring.
What is Pediatric CKD?
The kidneys play an essential role in a child’s overall health. They filter blood, removing waste products, toxins, and excess fluid from the bloodstream. The kidneys also maintain a balance of minerals and salts that circulate in the blood and balance hormones that create red blood cells and regulate blood pressure.
When the kidneys no longer function correctly, it can lead to health complications and, if left untreated, kidney failure.
Pediatric CKD refers to the progressive loss of kidney function over time due to conditions that reduce or damage kidney function. CKD is categorized into stages that define how severe the damage to the kidneys is and how well they can function.
CKD stages in children ages 2+:
- Stage 1: Kidney damage with normal or increased GFR
- Stage 2: Kidney damage with mild decrease GFR
- Stage 3a: Mild to moderate decreases GFR
- Stage 3b: Moderate to severe decrease GFR
- Stage 4: Severe decrease GFR
- Stage 5: Kidney failure
Signs and symptoms
Children with early-stage CKD may only have a few or no symptoms. As CKD progresses, the symptoms may include:
- Decreased or increased urine output.
- Edema (swelling) in the face, hands, feet, or legs
- A Foamy urine that is caused by proteinuria (too much protein in the blood)
- Stunted growth
- Decreased appetite
- Trouble concentrating
- Shortness of breath
- Feeling tired
- Hypertension (high blood pressure)
- Vomiting or nausea
- Itchy skin
Symptoms can differ from child to child, depending on the cause and stage of the kidney disease.
How common is kidney disease in children?
CKD in children is not very common, with researchers unsure of exactly how many children are affected by kidney disease. This may be attributed to the fact that many children present with few to no symptoms in the early stages of CKD.
Causes of Pediatric CKD
The causes of CKD in children are different than in adults. The most common causes of CKD in children are:
Congenital disabilities
In CKD, congenital disabilities are physical problems with the kidneys that the child has had since birth. These kidney problems occur during pregnancy. The most common congenital disabilities include:
- two kidneys with one kidney not working well or at all (renal hypoplasia)
- having only one kidney instead of two (renal agenesis)
- ureter or bladder abnormalities
- or an ectopic kidney where the kidney is in the wrong place
Most children that have congenital disabilities can live a full and healthy life. Talk to your child’s nephrologist or healthcare provider about how often they should undergo kidney checks.
Hereditary disease
Hereditary or inherited disease is a genetic disease that is passed down from either one or both parents through the genes to the child. While there is no way to prevent hereditary diseases, there are medicines that may help manage and treat them. The most common hereditary diseases that cause CKD in children include:
Kidney Infection
A kidney Infection generally occurs when a virus or bacteria enter the child’s body and causes illness. Most infections are treated with antibiotics and do not cause the child long-lasting damage. However, some infections lead the child to have an inflammatory response that causes damage to the kidneys. This may cause:
- Interstitial nephritis
- Glomerulonephritis
- Hemolytic uremic syndrome (HUS)
Nephrotic syndrome
Nephrotic syndrome is a group of symptoms demonstrating that the kidneys are not working correctly. Children generally start presenting with the following symptoms between the ages of two and six:
- Edma (swelling) in the feet, ankles, legs, and sometimes the hands and face
- Not enough protein in the bloodstream
- Too much protein present in the urine
- Focal segmental glomerulosclerosis
- Too much cholesterol or fat in the bloodstream
The most common cases of nephrotic syndrome in children are minimal change disease and diabetes.
Systemic disease
Systemic disease affects multiple organs in the child’s body. Systemic disease that causes CKD include:
Kidney trauma or injury
Trauma or injury to the kidneys may cause sudden kidney failure. For example, if the child experiences a severe drop in blood pressure, which reduces the amount of blood in the kidneys, causing damage, they may suddenly stop working. Other examples of kidney trauma may include:
- Surgery
- Medication injury
- Increased bleeding
- Dehydration
- A severe physical injury, such as a direct blow to the kidneys or an object punctures the skin into the kidneys
Urine blockage or reflux
The urinary system includes the ureters, bladder, kidneys, and urethra, which play a role in creating and removing urine from the body. Problems of the urinary system that can cause kidney disease in children include:
- Urine reflux
- A blockage of the urinary system
Common causes of kidney failure in children
Causes of kidney failure in children are based on the child’s age. Kidney congenital disabilities and hereditary diseases are the most common cause of kidney failure from birth to the age of four. In children aged five to 14, nephrotic syndrome, systemic diseases, and hereditary diseases are the most common causes of kidney failure.
From the age of 15 to 19, problems with glomeruli are caused by diseases such as Lupus and nephrotic syndrome, which are the common causes of kidney failure.
Complications of Kidney Disease in Children
- Cardiovascular disease (heart disease)
- Anemia
- Urinary incontinence
- Electrolyte imbalances in the blood
- Hypertension (high blood pressure)
- Cognitive issues
- Infection
- Mineral and bone disorder
- Metabolic acidosis
- Growth problems
Kidney disease may also affect children’s lives in other ways, affecting their behavior, self-esteem, and relationships. Children with CKD may also experience difficulty concentrating and learning and may have delayed development of language and motor skills.
How is Childhood Kidney Disease Diagnosed?
CKD in children over the age of 2 is diagnosed the same way as it is in adults. Healthcare providers use the child’s family and medical history and a physical exam to diagnose CKD. One or more of the following tests may be ordered:
- Urine tests
- Imaging tests
- Blood tests
- Kidney biopsy
- Genetic tests
Children under the age of 2 require testing methods other than eGFR, such as imaging or urine tests.
How is Pediatric CKD Treated?
There have been significant improvements in understanding how to care for children with CKD. Once CKD has been diagnosed, depending on the stage of CKD, the appropriate treatment and management can be determined by the nephrologist.
The main goals of treating pediatric CKD are to:
- Treat the underlying condition that is causing CKD
- Treat complications of CKD
- Prevent or slow CKD progression with medications and lifestyle changes
- In some children, prepare for kidney failure
Kidney failure in children is treated with kidney replacement therapy, such as a kidney transplant, hemodialysis, or peritoneal dialysis.
Clinical trials for CKD
Clinical trials for CKD conduct studies and trials for things such as:
- New ways to detect early signs of kidney disease
- Ways to improve current treatment options
- New treatment options to reduce symptoms or delay disease progression
Most children with CKD can lead an active and full life, from attending school to participating in the same sports as other children.
Panoramic Health
Panoramic Health is a physician-led, value-based kidney care platform where our priority is healthy patients. Our understanding and clinical engagement of CKD ensures that our patients receive better outcomes and care across the spectrum of CKD3-ESKD.
We offer our patients holistic care coordination, which helps slow disease progression, reduce hospitalizations, lower costs, improve rates of home dialysis, and improve overall quality of life. We believe that patients are more than a diagnosis and deserve a healthcare model that considers the full spectrum of their health.
