Chronic Kidney Disease in Children

Getting sick can feel like a normal part of growing up for any child. But, if your child is constantly sick or if symptoms point to their condition being serious, it can make you feel helpless and worry about their health. Such can be the case with chronic kidney disease. Despite the condition impacting an average of 12.1 million children per year, it can still be terrifying to see your little one dealing with the disease. You want to relieve their symptoms. But, how will the condition impact them long-term?

What is chronic kidney disease?

Your kidneys are bean-shaped organs that filter blood to produce urine, composed of wastes and extra fluid. They work around the clock to filter and remove waste from your body.

Chronic kidney disease (CKD) is a condition that permanently damages the kidneys. Over time, their kidney function decreases — making it more difficult to process food and clear out toxins. CKD is also commonly known as chronic renal disease or chronic kidney failure.

Cause of Chronic Kidney Disease

For most children, birth defects and hereditary diseases are the leading cause of CKD. But, they aren’t the only reasons. Chronic kidney disease can also be the result of:

Autoimmune disorders
Diabetes
Chemotherapy
Enlarged prostate in men
Glomerulonephritis — an inflammation of the kidneys’ filtering units
High blood pressure
Infection
Interstitial nephritis — an inflammation of the kidneys’ tubules and surrounding structures
Kidney Stones
Long-term use of certain medications
Lupus
Nephrotic syndrome
Polycystic kidney disease
Systemic diseases
Trauma
Tumors
Urinary tract infections, urine blockage, or reflux

Stages of Chronic Kidney Disease

There are five stages for CKD. Each stage is determined by the glomerular filtration rate (GFR). This establishes the level of creatinine in the blood. Healthy kidneys typically filter creatinine from the blood, so the levels should be low. But, as your child’s kidneys fail, their level of creatinine will increase.

Stage 1

Stage 1 has a normal GFR or greater than 90 ml/min. Kidneys are fairly good at filtering, even when they aren’t at 100%. That’s why at this stage, there are typically no symptoms of chronic kidney disease. Most people won’t know they have Stage 1 unless they’re being tested for diabetes or high blood pressure. Since most children don’t experience these issues, it’s likely you won’t know your child is experiencing CKD until a later stage.

Stage 2

Children experiencing Stage 2 will have a glomerular filtration rate of 60-89 ml/min. This demonstrates some mild kidney disease, but is typically similar to Stage 1 in that it’s not noticeable, and there will be no symptoms. As with the previous stage, testing for diabetes or high blood pressure is usually the only way CKD is discovered at this level.

Stage 3

Stage 3 is broken up into two levels: 3A and 3B. Stage 3A has a decrease in GFR to 45-59 mL/min, and Stage 3B shows a decrease in GFR to 30-44 mL/min. At these stages, waste products can build up in the blood (uremia). This can also produce symptoms, such as:

Fatigue
Fluid retention, swelling (edema) of extremities, and shortness of breath
Urination changes — such as foamy, dark orange, brown, tea-colored, or red if it contains blood and urinating more or less than normal
Kidney pain felt in their back
Sleep problems due to muscle cramps or restless legs

Stage 4

At Stage 4, kidney damage is considered advanced with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. At this stage, your child may need dialysis or a kidney transplant in the near future. In addition to uremia, your child is likely to develop complications of kidney disease — such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease, and other cardiovascular diseases. Common symptoms include:

Stage 3 symptoms
Nausea and/or vomiting
Taste changes — such as a metallic taste in the mouth
Bad breath due to buildup in the blood
Loss of appetite
Difficulty concentrating
Nerve problems — such as numbness or tingling in the toes or fingers

Stage 5

The final stage has a glomerular filtration rate (GFR) of 15 ml/min or less. At this stage, your child will develop end-stage renal disease (ESRD), which means that their kidneys no longer function to the body’s needs. Their kidneys will no longer function effectively, and dialysis or a kidney transplant will be needed. Symptoms of Stage 5 CKD include:

Loss of appetite
Nausea or vomiting
Headaches
Fatigue
Being unable to concentrate
Itching
Making little or no urine
Swelling — especially around the eyes and ankles
Muscle cramps
Tingling in hands or feet
Changes in skin color
Increased skin pigmentation

Signs & Symptoms of CKD

Symptoms of chronic kidney disease will depend on what stage your child is at. As your child’s kidney fails, they may develop new signs of kidney damage, or symptoms may worsen. Typically, the most common symptoms of CKD include:

Fever
Swelling around the eyes, face, feet, and ankles (called edema)
Burning or pain during urination
Significant increase in the frequency of urination
Difficulty in controlling urination — in children who are mature enough to use the toilet
Recurrence of nighttime bedwetting — in children who have been dry for several months
Blood in the urine
High blood pressure, feeling more tired and have less energy
Difficulty concentrating
Decrease in appetite
Muscle cramping at night
Dry itchy skin

Diagnosis & Treatment

If kidney disease is suspected, your pediatrician will discuss your child’s medical history as well as your family history, do a physical exam, and order urine tests, blood tests, imaging studies, or a biopsy to help make a diagnosis. The blood test will help determine the GFR — giving you insight into which stage of CKD your child is currently at.

Once diagnosed, treatment options will vary and mostly be targeted at relieving symptoms until your child is at Stage 4 or 5. A nephrologist — a doctor who specializes in treating kidney diseases and kidney failure in children — can help you determine the best treatment plan for your child. Plans may include:

Prescriptions for angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics
Blood pressure medications
Treatment for anemia and growth failure — such as hormones and dietary changes
Dialysis
Kidney transplantation

Contact Sonas for Home Health Care in Florida

It can be hard to balance your time between work, home, and caring for a child. That’s why our team of skilled professionals at Sonas Home Health Care is here to help.

Our home health care services offer support in the comfort of your home. We refer loving and competent nurses to provide customized care for families — from a few hours a day to around-the-clock supervision. Contact us directly to speak with a home health care professional or request a free in-home assessment. Together we can determine the best plan of action to keep your loved ones happy and healthy.

If you or a loved one are considering Pediatric Home Health Care services in Florida, contact the caring staff at Sonas Home Health Care. Call today at (888) 592-5855.

Jillian Miller BSN, RN

Director of Nursing at Sonas Home Health Care

This blog was reviewed by Jillian Miller BSN, RN — Director of Nursing for Sonas Home Health Care’s Tampa Bay market — for clinical accuracy. Jillian Miller has been a nurse for 16 years — working primarily in pediatrics. She believes the best part of working with the pediatric population is when you see smiles from clients when you first enter the room. She loves seeing the difference you can make in families’ lives while providing the best care possible for them.