How to detect kidney disease in childhood

To understand a little about the initial symptoms that children with kidney disease present, it is important to have an understanding of kidney functions.

The kidneys play a vital role in the process of purifying our blood and detoxification, as well as most of the waste elements of the body’s cellular processes. This is achieved through a functional basic structure of the kidney which is the nephron.

Here the absorption and excretion of water, salts, electrolytes, PH level of the organism are regulated and many products of metabolism are eliminated.

Some hormones are also produced in the kidney:

• Erythropoietin, which is involved in stimulating the bone marrow to make red blood cells or erythrocytes.
• Vitamin D, essential for the absorption of calcium and bone formation.
• Finally, renin, which has functions at the level of blood vessels and blood pressure control.

Kidney diseases can be acute or chronic

Acute kidney disease occurs suddenly due to a kidney or general cause. It is secondary to infections, sepsis, shock of any origin, heart failure, severe dehydration, poisoning, medications and drugs. They are treated by combating the cause that originated the kidney failure, and the damage is usually reversed completely without leaving sequelae in the kidney function.

In the case of chronic kidney diseases , the damage is established progressively, but they are generally irreversible. They are caused by other types of medical problems, particularly in children.

Epidemiological aspects

There are not many statistics regarding kidney disease in children . In the United States, there are approximately 18 children on dialysis for every million people.

Kidney disease is more common in men, about 65%.

The most frequent causes are structural or anatomical.

In Europe, it has been reported that there are 10 to 12 patients per million. Particularly in Spain, if the milder stages are included, this frequency increases to 128 patients per million.

The frequency of African-American race in the United States is 3 times higher than the rest of the population.

Structural causes constitute 57% of cases, hereditary diseases and polycystic kidney disease represent 16%, vascular causes 9.4% and finally glomerulopathies 5%.

Chronic kidney disease in children is considered when there is structural or functional damage for at least 3 continuous months, with the findings of:

• Abnormalities in blood or urine values
• Alterations in imaging studies
• Changes in kidney biopsy
• Low glomerular filtration, measured by laboratory.

Main causes

Unlike adults, the main causes of kidney damage are diabetes and high blood pressure; in children, the causes are more varied.

• Congenital malformations : among them we can get obstructive uropathies, reflux nephropathy or vesico-ureteral reflux that causes fetal hydronephrosis, duplication of ureters, horseshoe kidneys, renal dysplasia or hypoplasia.

All these diagnoses are made in the newborn, usually with many clinical and laboratory manifestations that make the kidney problem evident.

• Hereditary diseases : the most common of which is polycystic kidney disease or polycystic kidney. Rarer inherited diseases such as cystinosis, oxalosis, and nephroptosis can also be seen.
• Urinary infections : the most involved microorganism is Escherichia coli , it is more frequent in male children in the first year of life, due to the higher frequency of urological abnormalities. This frequency of urinary tract infections is equal in females after 5 years of age.
• Other causes : like Wilms tumor, it is a common type of childhood cancer, which appears before 2 years of age, can be treated and cured by surgery and chemotherapy.
• In adolescents, the main cause is of the glomerular type: Glomerulonephritis, which are not related to anatomical or hereditary problems.

Clinical manifestations

The clinical manifestations are going to be a direct consequence of the renal function alterations:

1. Problems in the regulation of fluids and electrolytes (sodium and potassium).
2. Due to accumulation of toxic metabolites that are normally eliminated by the kidney (urea).
3. Loss of synthesis of certain hormones: erythropoietin and vitamin D3.
4. Alterations in the response to endogenous hormones such as growth hormone.

Common symptoms for children are:

• Swelling or edema (even mild) of the hands and feet, mainly in the evening. Affecting the child’s ability to move or move.
• Inflammation or edema in the eyelids, around the eyes, mainly in the morning, caused by excessive accumulation of fluid.
• In addition to the feet, hands and face, there are also other signs of edema that should attract the attention of parents, such as the marking of the socks or the belt.
• Lack or decreased appetite. This is especially striking and you must maintain your appetite and good nutrition because eligibility for a kidney transplant is closely related to nutritional and growth factors.
• Changes in frequency of urination. It can be increase or decrease. Also burning to urinate.
• The appearance of Enuresis or lack of control of urination during sleep, in children older than 5 years, who already controlled their sphincters at night. Or recurrent or intermittent enuresis.
• Changes in the appearance of urine, either in its color, urine darker due to concentration or blood (hematuria). Very foamy urine may also be seen due to abnormal excretion of albumin (proteins).
• Headache or headache secondary to high blood pressure or anemia.
• Nonspecific gastrointestinal symptoms (due to high blood urea): nausea, vomiting, changes in bowel movements.
• Impaired growth and development, which is particularly important in the first year of life.
• General weakness
• Children do not want to play or do sports.
• Difficulty concentrating.
• Poor school performance.
• Pale from anemia.
• Low tolerance to exercise and dehydration.
• Depression, especially in adolescents.
• Delayed puberty.
• Lack of growth in adolescence.