Preventive Measures for Pediatric Renal Conditions

Introduction:

Kidney diseases include conditions that result in damaged kidneys, which lead to fluid and waste accumulation in the body as the kidneys cannot filter blood properly. Acute kidney injury is a sudden decrease in kidney function that mostly lasts for a short period of time. The condition can result in long-lasting effects and can be life-threatening if left unattended. Chronic kidney diseases develop over a longer period and can lead to kidney failure. Kidney diseases are uncommon in children; most children present with few or no symptoms during the initial stage of the disease. Chronic kidney diseases are more frequent in male children than female kids, and black children are more likely to be affected than white children.

What Are the Causes of Pediatric Renal Conditions?

The causes of kidney diseases in children include:

• Birth Defects - Birth defects that affect the normal development of the urinary tract. These include conditions like renal hypoplasia (characterized by smaller kidneys and fewer nephrons).

• Infections - Infections that occur in the body may result in renal diseases.

• Urine Blockage - Conditions that result in urine blockage may result in urine flowing back to the kidneys, resulting in damage.

• Trauma - Traumas such as bleeding, burns, dehydration, etc., result in reduced blood flow to kidneys, resulting in acute renal failure.

• Hereditary Diseases - Hereditary kidney diseases that affect children are polycystic kidney disease (cysts develop within the kidney that damage it over time) and Alport syndrome.

• Systemic Diseases - Systemic diseases affect multiple organ systems.

• Nephrotic Syndrome - In this condition, protein leaks into urine from blood due to damage to glomeruli.

What Are the Symptoms of Renal Disease in Children?

Children may show fewer or no symptoms in the early stages of renal diseases.

The symptoms that develop mostly in the advanced stage are:

• Swelling in the face or extremities.

• Hematuria (bloody urine).

• Foamy urine.

• Decreased or increased urine output.

Other symptoms are:

• Weakness.

• Nausea.

• Vomiting.

• Fever.

• Reduced appetite.

• Shortness of breath.

• High blood pressure.

• Stunted growth.

• Itchy skin.

• Trouble concentrating.

What Are the Possible Complications Associated With Kidney Disease in Children?

The possible complications include:

• Bone disease.

• Pain in joints, muscles, and bones.

• Poor nutrition.

• Increased risk of infections.

• Cognitive issues.

• Anemia.

• Problems with blood vessels and heart.

• Increased blood pressure.

• Electrolyte issues in blood.

• Growth issues.

What Are the Diagnostic Tests?

• Blood tests to detect glomerular filtration rate.

• Urine tests to detect proteins in urine and to detect the filtering ability of kidneys.

• Imaging tests to detect abnormalities in the kidney.

• Genetic tests to detect genetic mutations.

• Kidney biopsy to detect kidney damage.

What Are the Preventive Measures?

Chronic kidney disease (CKD) has been globally recognized as a significant problem in children. CKD can lead to end-stage renal disease.

CKD has been divided into 5 stages:

• Stage 1 - Kidney damage is present. GFR (glomerular filtration rate) is normal or increased.

• Stage 2 - Kidney damage is present. GFR reduction is mild.

• Stage 3 - GFR reduction is moderate.

• Stage 4 - GFR reduction is severe.

• Stage 5 - Kidney failure.

The prevention process involves three important aspects. The main goal of primary prevention is to reduce or eliminate exposure to factors that may result in renal disease. In the case of CKD, these involve measures to reduce antenatal (before childbirth) exposure to drugs, infection, and prevention of hereditary disease or congenital disorders through genetic counseling, obesity prevention, proper management of diabetes mellitus and hypertension, and early detection. Secondary prevention involves measures taken to prevent the progression of kidney damage from stage 1 to 5. Tertiary prevention mainly focuses on the delay or reduction of long-term complications and disabilities associated with the condition.

Antenatal Preventive Measures

• Infections that occur in the intrauterine period may result in congenital nephrotic syndrome.

• Antenatal preventive measures include antenatal immunizations to prevent rubella infections.

• Preventive measures include proper screening and treatment of toxoplasmosis (a parasitic disease caused by the protozoa Toxoplasma gondii) and cytomegalovirus infection.

• If indicated, children with a familial history of end-stage renal disease should be frequently examined for proteinuria, renal function, and abdominal ultrasound.

• Premarital genetic evaluation and counseling is a preventive measure to prevent congenital diseases.

• Early renal disorders can be detected through amniotic fluid cytology, antenatal ultrasonogram, maternal serum alpha-fetoprotein estimation, and chorionic villi sampling.

Postnatal (after childbirth)Preventive Measures

• Antenatal diagnosis of congenital anomalies helps in postnatal evaluation. The evaluation tests include renal function tests, abdominal ultrasounds, isotope evaluations, etc.

• Early diagnosis aids in ensuring adequate urine drainage. Surgical intervention measures are taken in cases of obstructive uropathy. These help in preventing renal damage.

• Birth weight is one of the determinants of renal disease risk. Low birth weight, along with prematurity, increases the susceptibility to renal diseases in the later stages of life. Low birth weight infants have fewer nephrons, which predisposes to altered renal function, hypertension, and cardiovascular events in adult life.

• Acute renal failure occurs due to complications following systemic conditions, which include solid organ transplantation, neonatal care, bone marrow transplantation, heart surgery, etc. Therefore, long-term evaluation of children for kidney damage is necessary in cases of such systemic conditions.

Screening Procedures for Early Detection

• Hypertension may be an initial indicator of chronic kidney disease in both children and adolescents. Patients with hypertension and CKD are at increased risk of developing cardiovascular diseases and losing kidney function. Systemic hypertension may directly damage the blood vessels of the nephrons.

• Proteinuria (high protein level in urine) is a marker of CKD severity and kidney injury and a predictor of the progression of the condition.

• Microalbuminuria is a condition characterized by excretion of albumin above the normal range. It is a sensitive test and can be used for the early detection of glomerular injury.

Conclusion:

Renal issues in children are difficult to diagnose early as symptoms are fewer or nil in the initial stage. Preventive measures that can be taken include antenatal measures like genetic evaluation, immunizations, etc. Postnatal preventive measures include early diagnosis through evaluation tests. Preventive measures taken can reduce mortality and morbidity associated with pediatric renal issues.