Source: Kidney disease in children: Why it matters | The Herald
For every human being, kidneys are one of the most important organs and play a critical role in the body.
Acting as the body’s filtering system, they help control water levels and eliminate wastes through urine. They also help regulate blood pressure, red blood cell production, and the levels of calcium and minerals.
But sometimes the kidneys may not function properly due to various reasons leading to a kidney disease.
Kidney disease (renal failure) is short-term or permanent damage to the kidneys that results in loss of normal kidney function.
Acute kidney disease starts suddenly. In some cases, it may be reversed and the kidneys can work normally again.
Chronic kidney disease gets worse slowly over at least three months. It can lead to permanent kidney failure.
Zimbabwe joined World Kidney Day commemorations on March 9 and key among the messages was the importance of recognising that kidney disease can have a detrimental effect on the health and life of all, young and old.
Globally, one in every 10 people are affected by chronic kidney disease, which translates to about 850 million people affected at various stages.
There is a projection that CKD could become the fifth leading cause of death by 2040 highlighting the importance of having more efforts channelled towards prevention of progression of chronic kidney failure.
However, when people talk about such diseases, they only think about their effect on adults. Rarely do people think that children could also be affected.
But studies have shown that several causes of kidney disease first begin in childhood.
While data regarding the prevalence of paediatric kidney disease is lacking, experts say risk factors for childhood kidney disease are common in Africa.
Kidney disease in children can be caused by birth defects which occur when part of a baby’s body does not develop normally when the baby is in the womb, hereditary diseases may also cause kidney disease.
A child may develop kidney disease after having an infection in another part of the body or due to systemic diseases that affect many organ systems or the entire body such as lupus nephritis.
Traumas such as burns, dehydration, bleeding, injury, or surgery can also cause very low blood pressure, which decreases blood flow to the kidneys and can lead to acute kidney injury or failure.
Also, if a blockage develops between the kidneys and the urethra, urine can flow back up into the kidneys and cause damage.
Experts believe the most common kidney diseases in children are usually present at birth and can even be picked up before then through ultrasound scans.
But because many women in low income countries like Zimbabwe rarely go for anomaly scans during pregnancy, kidney disease may not be identified early.
According to paediatric nephrologist Dr Privilage Makanda-Charambira, it is important for pregnant women to get ultrasound scans, especially in the last trimester of their pregnancy.
“Pregnant women should get ultrasound scans, not only to know the sex of their baby but to get an anomaly scan which looks for any abnormalities and one of the things they look at is the kidneys. When you get an anomaly scan done, some of these problems can be found in utero and by the time the child is delivered, you can start interventions to not necessarily stop the process but to retard its progression,” she said.
For children whose conditions are not picked before birth, the disease could be more deadly as it may remain silent only to be discovered at very late.
However, there could be symptoms that may warn parents and caregivers of a potential problem.
The signs and symptoms may vary from child to child and include fever, swelling around the eyes, face, feet, and ankles (called edema), burning or pain during peeing, significant increase in the frequency of urination, difficulty in controlling urination in kids who are mature enough to use the toilet, recurrence of night-time bedwetting (in kids who have been dry for several months), blood in the urine and high blood pressure.
But not all symptoms will be noticed early hence, as Dr Charambira said, it would be important to have regular checks for children form the age of three.
“For children, kidney disease is usually silent, when it then pops its head, usually it’s at the end of the spectrum. What we need to be pushing for is preventative measures and also screening for young children so that we are able to actually pick up kidney disease early. Every child from the age of three years is supposed to have a yearly blood pressure check and urinalysis. These are simple non-invasive things that should be done for every child,” she said.
She said pre-term babies and children who suffer renal injury during their neonatal or infant years should get urinary and blood pressure checks earlier.
While there is limited data on kidney disease among children in Zimbabwe, Dr Charambira says a study done last year at Parirenyatwa Group of Hospitals had shown that there was a high prevalence of kidney disease in Zimbabwe.
“We do not have statistics for the whole country to help us assess the burden of kidney disease but last year between January and August, we collected data on all the paediatric patients who were admitted at Parirenyatwa and we found that of the more than 2000 patients who were admitted during that time period, about 2,2 percent had a kidney ailment of some sort. This is actually a very high figure and it’s comparable to that which is found in other countries. Of that 2,2 percent we had a mortality of about 32 percent so that meant 32 percent of children who were admitted at Parirenyatwa with a kidney ailment deceased. While we only looked at one institution, there are so many children with kidney disease and we get referrals from all over the country,” she added.
For most patients, dialysis is the only way they may survive kidney disease.
Dialysis helps to keep renal patients’ bodies in balance by removing waste, salt and extra fluids from the blood to prevent them from building up in the body. It often involves diverting blood to a machine to be cleaned.
A person on dialysis can actually live a long and comfortable life.
However, for children, dialysis, which is a lifetime intervention, can be difficult.
“As paediatric nephrologists we actually advocate for transplantation for our patients with end stage kidney disease because you can imagine if a child is diagnosed at five, they will need to be on dialysis for the next 35 years or so and that might not be possible. For young children diagnosed with end stage kidney disease they are put on dialysis as an interim measure while you prepare them for transplantation because that is the end goal for them,” said Dr Charambira.
Complications of kidney disease in children may include anaemia, heart disease, electrolyte imbalances in the blood, growth problems, high blood pressure, infections, metabolic acidosis, mineral and bone disorders, cognitive issues and urinary incontinence among others.
Kidney disease can also affect children’s lives in other ways, causing problems related to behaviour, relationships, and self-esteem.
Children with CKD may have difficulty concentrating and learning, and may develop language and motor skills more slowly than their peers.
So like any other disease, prevention of kidney disease may be a better and less expensive option.
“Everyone knows that it is important to drink plenty of water and avoid dehydration but for children, avoiding or treating constipation is important. People take constipation as if it is nothing special but it is detrimental to the kidneys as it increases the risk of a child getting urinary tract infections which in turn can cause some malfunction of the bladder. If the bladder starts malfunctioning, it will also damage the kidney. So we need to encourage good toilet habits where children do not hold urine for too long as this is not good for the bladder,” said Dr Charambira.
But most importantly, taking a child to see a health professional whenever they exhibit signs of being ill could save their kidneys and their lives