Nephrological Problems In Children - An Overview

Introduction

Nephrological problems in children refer to a range of kidney-related conditions that affect the pediatric population. The kidneys play a crucial role in maintaining the body's overall health by filtering waste products from the blood, regulating fluid and electrolyte balance, and producing important hormones. When nephrological problems arise in children, they can have significant impacts on their growth, development, and overall well-being. These conditions can be congenital, acquired, or related to underlying systemic diseases. Common nephrological problems in children include urinary tract infections, kidney stones, nephrotic syndrome, congenital abnormalities of the kidneys, and chronic kidney disease. Early identification and appropriate management of these issues are vital to prevent further complications and promote healthy kidney function.

What Are the Types of Kidney or Nephrological Disease?

• Acute Kidney Injury (AKI): AKI developed quickly, causing decreased kidney function. It is a result of some underlying cause. If left untreated, it will cause renal failure leading to death.

• Chronic Kidney Disease (CKD): CKD develops over a long period of time. It may result in renal failure or end-stage kidney diseases. Children suffering from CKD will need a kidney transplant or dialysis to stay fit. Eventually, it may lead to death if left untreated.

What Are the Complications of Nephrological Problems?

• Anemia.

• Heart diseases.

• High sodium in the blood leads to electrolyte imbalance.

• Blood pressure rises (hypertension).

• Increased risk of infection.

• Bone disorders.

• Cognitive problems.

• Metabolic acidosis.

• Mineral imbalance.

• Urinary incontinence (loss of bladder control).

• Low self-esteem in children.

What Are the Signs and Symptoms?

Symptoms vary from child to child. Some common symptoms are:

• Edema (swelling) in legs, feet, hands, and face.

• Proteinuria (proteins in the urine).

• Hematuria (pink or cola-colored urine).

• Loss of appetite.

• Lethargic.

• Fever, malaise.

• Itching of skin.

• Nausea and vomiting.

• Inability to concentrate.

• Shortness of breath.

• Sudden or gradual loss of weight.

• General weakness.

• Growth is stunted.

What Are the Causes of Nephrological Problems?

• Congenital Deformities In Kidneys: The kidney does not develop normally when the baby is in the womb. Examples are renal agenesis (baby has only one kidney or both kidneys are missing), kidney dysplasia (when nephrons are not formed normally), and renal hypoplasia (when the baby is born with a smaller kidney and nephrons are lesser in number than normal).

• Hereditary Diseases: When a genetically mutated gene passes from any of the parents to the baby, it results in a hereditary disease. Examples are polycystic kidney disease (multiple cysts cause kidney damage) and Alport syndrome (disease due to damage to the outer lining of kidneys).

• Infections: Bacterial infections can cause kidney failure. Examples are hemolytic uremic syndrome (caused by E. Colin), a condition in which the kidney, post-streptococcal, or post-infectious glomerulonephritis destroys red blood cells.

• Systemic Diseases: Examples are lupus nephritis caused by systemic lupus erythematosus.

• Trauma: Trauma includes burns, dehydration, bleeding, injury, consistent low blood pressure from surgery, or chronic cases that can lead to kidney failure.

• Urine Blockage Or Reflex: Blockage occurs between the kidneys and urethra, which can cause backflow of urine and damage the kidneys.

What Is Nephrotic Syndrome?

The glomeruli cause nephrotic syndrome; glomeruli consist of tiny filters in the kidney that cannot carry out their function and lead to the leaking of proteins into the urine. The most common causes of nephrotic syndrome are scarring of glomeruli (focal segmental glomerulosclerosis), a disorder that can lead to damage in glomeruli (minimal change disease), disorders that can affect the immune system causing the buildup of antibodies in the membrane of kidneys thus causing damage to the glomeruli (membranoproliferative glomerulonephritis).

How to Diagnose Nephrological Problems in Children?

• Physical Examination: It includes complete family history, child's medical history, and complete physical evaluation.

• Urine Test: To evaluate the urine for kidney function and check for proteins in urine.

• Blood Test: To check for any underlying disease.

• CT (computed tomography) and MRI (magnetic resonance imaging).

• Imaging Test: To locate kidneys and check size, shape, or abnormalities.

• Kidney Biopsy: To look for kidney damage and find the cause of the damage.

• Genetic Test: To identify genetic mutations.

• Other Scans Are Voiding Cystourethrogram (VCUG) and Renal Nuclear Scan: (a special radioactive material injected into the vein).

What Are Treatment Options Available for Nephrological Problems in Children?

• Medications: Doctors may prescribe medication to treat the underlying condition or control kidney damage. Examples are antibiotics for infections, diuretics, angiotensin-converting enzyme (ACE) inhibitors, phosphate binders, growth hormones, and sodium bicarbonate.

• Dialysis: In cases of acute kidney failure, dialysis will help the kidney to recover. Dialysis can take kidney function till kidney recovery or till a transplant is available for kidney failure.

• Steroids: They help in reducing inflammation.

• Dietary Changes: Parents and children must follow dietary restrictions, including limiting proteins, sodium, phosphorus, potassium, and liquids. It is important to include vitamins and mineral supplements regularly.

• Kidney Transplant: If the child suffers from kidney failure, they need a kidney transplant. Sometimes, a transplant is done before dialysis. It is known as a preemptive transplant. Others receive dialysis till they have a transplant. A kidney from the parents is a better option than someone else as it will match.

• Hemodialysis: In hemodialysis, a machine purifies wastes, salts, and fluid from the blood when the kidneys are not healthy enough to do this work adequately. It is done in place of dialysis three times a week.

• Peritoneal Dialysis: Peritoneal dialysis is used to remove excess fluid, remove toxins and correct the electrolyte imbalance from kidney failure.

• Clinical Trials: Clinical trials help the child to try on new medicines and their effects, but the side effects are not known.

What Can Parents Do If the Child Has Kidney or Nephrological Problems?

Track the water consumption of kids, get a proper guideline from the doctor about the water consumption, and follow the diet chart prescribed by the doctor. Ensure that the child takes all the prescribed medicine, and also let the doctor know if the child is facing any side effects. Most importantly, talk to the child about their problems, help them to deal with all appointments, and be available for them.

Conclusion

Kidneys are important for maintaining good health. Nephrological problems in children can majorly impact a child's life. Dietary modification and medication will help in the treatment. Early diagnosis can give multiple treatment options and help in having a good quality of life.