Categories: Nephrology

What work do the kidneys do?

The kidneys clean the blood and keep it pure. They throw away all the excess water, salt, and bad chemicals from the blood into the urine and keep back all the good things that the body needs. Most normal people have two kidneys to do this work.  The entire blood is cleaned almost 30 to 50 times a day. Each kidney has one million tiny filters called “Nephrons” to do this work. As the blood flows through the kidneys, they must pass through these filters who act as very efficient security guards.

Why do children have kidney problems?

Children may have kidney problems because of three reasons:

  1. They may be born with small kidneys that have very few filters and so cannot clean the blood efficiently.
  2. Some children may have normal filters but they may be born with drainage problems. They may have valves that block the flow of urine and cause swelling in the kidney. These are seen only in boys and are called “Posterior Urethral Valves” or PUV in short.
  3. Some children have normal filters and normal drainage at birth but may later develop diseases that damage the filters causing the filters to become leaky. They leak proteins or blood in the urine. Such diseases are known by names such as “Nephrotic Syndrome” or “Glomerulonephritis”. Kidneys can also get damaged by urinary infections, stones, and certain medications.

How will parents know if their child has a kidney problem?

Common symptoms and signs include:

  • Swelling over the eyes especially in the mornings.
  • Change in urine colour; red, pink, cola coloured, hazy, white or frothy.
  • Pain while passing urine or straining while passing urine. A thin, weak stream of urine or passing urine in drops.
  • High fever without any cold and cough may be a sign of urinary infection.
  • Children who had abnormal-looking kidney while the sonography is done before birth or later in life.
  • Children who pass urine less than 4 times or more than 10 times in the day.
  • Children who regularly get up at night to drink water and pass urine.
  • Sometimes the child may have no symptoms but may not be growing well and is among the shortest three in the class or has crooked legs or has anemia that does not improve with iron therapy.

What are the common kidney diseases in children?

Some of the common kidney diseases that affect children are:

  • Nephrotic Syndrome – The child has severe swelling over the eyes, and the body, and the urine show proteins.
  • Glomerulonephritis – The child may have a mild swelling over the eyes and the body, blood in the urine, pass less urine and may have high blood pressure.
  • Urinary tract infections – High fever without a cause, vomiting, stomach pain, burning sensation when passing urine. All children with urinary infection should be treated promptly and undergo tests to check whether they have some birth defects in the kidney or the urinary tract.
  • Congenital anomalies of the kidneys and the urinary tract – These are of many kinds. Many of these are detected during the sonography done by the mother during pregnancy. These should always be re-checked after birth and watched closely. Many of these may settle as the child grows older but some of them may have serious problems. Any kidney that looks abnormal on sonography should have the benefit of expert evaluation by a pediatric nephrologist.

Can kidney diseases be cured?

Fortunately, many of the diseases we see in children can be cured if diagnosed early and treated rightly and on time. Many of the diseases may require many years of treatment.

Can children’s kidneys fail?

Yes. Some children get kidney failure. This occurs when the kidney filters are too few at birth or they get severely damaged by disease.

Can kidney failure be treated?

Yes. With proper medication, diet, and periodic monitoring these children can remain well, go to school and do all normal activities. However, when the kidney is doing less than 20% of its function medications alone may not be enough to keep them well. These children may need artificial filters to clean their blood. This process of using artificial filters to clean the blood is called “Dialysis”. Dialysis can be done even in very small children.

What is the best treatment for kidney failure?

The best treatment for kidney failure is kidney transplantation. A new kidney can be transplanted surgically into the child. A healthy parent or a grandparent with two normal healthy kidneys can safely donate one kidney to the child and live a normal life.

Tips to keep your child’s kidneys safe:

  • Let your child drink plenty of water.
  • Don’t let your child hold back the urine. A child should pass urine at least 6 to 8 times in the day.
  • Reduce eating salty foods like pickles, papads, wafers, chips, soya sauce and additional salt on salads and soups.
  • Always do a urine test if your child has a high fever.
  • Get your child’s blood pressure checked once a year. High blood pressure can be due to kidney disease.
  • Do not give strong medications for fever. It can harm your kidney. For fever, use medications that contain only paracetamol.
  • Let your child have at least one hour of outdoor physical activity daily. Encourage participation in sports, dance or gymnastics. This will prevent your child from getting overweight. Obese or overweight children are at risk of high blood pressure and added burden on the kidney.
  • If your child is among the shortest 3 children in the class, it may be a reasonable idea to get him checked to make sure that he/she does not have a kidney problem. He or she may need a few tests such as urine examination, sonography of the kidneys, and blood tests such as creatinine and blood gases to rule out the presence of kidney disease.
  • Don’t fall prey to claims that someone can cure all diseases like epilepsy, asthma, cancer and kidney disease. There are no magic bullets. Many of these advertised treatments have heavy metals that can damage the kidney.
  • Never ignore any abnormal findings on urine examination or sonography. Make sure you get an expert opinion.
  • Finally, if your child has a kidney problem that has lasted for more than 3 months or has a high blood creatinine level you must consult a specialist in kidney disease for children.
  • At our hospital, a child with kidney or urinary problems is taken care of by the Paediatric Nephrology Team, who are available round the clock, with daily outpatient care, and 24×7 availability for emergency care.

The services include:

  • Consultation with the specialists, appropriate laboratory, ultrasound and radiological tests for diagnosis, a facility for USG guided kidney biopsy if needed.
  • Comprehensive care with medications, dietary advice, and attention to the growth and well-being of the child.
  • Dialysis facility is available for children with acute and chronic kidney failure.
  • Advance Critical Care management.

Dr. Uma Ali and Dr. Vaishali More, Nephrology – Paediatric, SRCC Children’s Hospital, Mumbai

Narayana Health

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