Chronic Kidney Failure

The kidneys have about 1,000,000 little filters, called nephrons [NEF-rons]. Each nephron works to filter wastes out of small amounts of blood all the time. This filtering process also controls the levels of minerals like sodium (salt) in your child’s body.

When these parts don’t work properly, waste builds up in the body. Although chronic kidney disease may have no symptoms, the early signs and symptoms of kidney failure may include:

• Puffiness, usually in the face
• Swelling of the feet and ankles
• Needing to pee a lot
• Wetting the bed in children over 5 years old
• Poor growth compared to other kids of the same age
• Not being hungry
• Feeling queasy almost all the time
• Bad headaches
• Pale skin
• Feeling tired

As your child’s kidneys get worse, they may also have:

• Changes in their skin color
• Pain in their bones
• Trouble focusing
• Trouble sleeping
• Numbness in their hands and feet
• Muscle twitches
• Cramps
• Bad breath
• Bruises that happen easily
• Extreme thirst
• Vomiting
• Blood in their urine (pee) or stool (poop)

You should take your child to see a doctor if you notice the symptoms of kidney failure. Often the signs are unclear until much of the kidney function has been lost. At that point, your child may show these signs:

• Feeling tired
• Not being able to concentrate
• Feeling confused
• Feeling queasy
• Vomiting
• Puffiness in the face

If your child has already been diagnosed with chronic kidney disease, they need to visit the doctor regularly. You should get medical help right away if they have:

• A heart rate that’s too fast or too slow
• Pain in the chest
• Shortness of breath
• Severe weakness

Kidney failure happens when the kidneys are permanently damaged and lose function because of:

• Birth defects, such as being born with 1 kidney
• Inherited diseases
• Infections
• Systemic diseases, such as lupus
• Nephrotic syndrome
• Glomerulonephritis
• Trauma
• Urine blockage, when urine cannot travel out of the body
• Reflux, when urine flows back to the kidneys

It’s possible to find some kidney problems before birth with an ultrasound. Other kidney problems stem from a separate condition, so your child’s doctor will be looking for signs of kidney disease if that’s the case.

Much of the time, concerns about a child’s symptoms leads to tests that diagnose chronic kidney failure. These tests include:

• Urinalysis (UA), where your child’s urine is checked for protein that could be a sign of kidney damage
• Blood tests, which can show the level of kidney function and levels of minerals in the bloodstream
• Imaging studies, where a picture of the kidney is made, usually with an ultrasound or x-ray
• Biopsy, where a doctor takes a sample of tissue from your child’s kidney to be viewed with a microscope

Because chronic kidney disease cannot be “cured,” your child’s doctor will work to prepare your child in case of complete kidney failure. To slow the progression of your child’s condition, they will:

• Treat any other condition that is making your child’s kidney failure worse
• Manage the symptoms your child has
• Change your child’s diet to help make less work for the kidneys

When your child reaches the end stage of chronic kidney disease, the kidneys lose all function. To survive, your child will need dialysis or a kidney transplant. Your child’s doctor will talk through these options with you:

• Kidney transplant. This involves surgery to put a healthy kidney from a living or deceased donor into your child’s body. That donated kidney will replace the work done by their failed kidneys. Other health problems, finding a donor in time, surgery complications, medicine side effects, or cost could rule out this option.
• Dialysis. This treatment filters your child’s blood either outside your body using a special machine or inside your body using the lining in your belly (abdomen). Both methods require a brief, up front surgical procedure.

Some types of chronic kidney disease cannot be prevented. For others, you can lower your child’s risk by ensuring that your child:

• Goes to the bathroom as soon as they need to pee
• Drinks plenty of water
• Eats a diet that is low in salt
• Exercises as appropriate for their age
• Visits the doctor yearly for check-ups

Chronic [KRON-ik] kidney disease happens when your child’s kidneys slowly lose their ability to function. Your child’s kidneys are vital organs that clean their blood by removing wastes, extra salt, and fluid. The kidneys turn these wastes into urine [YOOR-in] (pee). While chronic kidney disease in adults is often caused by diabetes or high blood pressure, the causes in children are usually different. Your child is more likely to get high blood pressure from the failure of their kidneys than the other way around.

In babies and young children, the problems that lead to chronic kidney disease include:

• Birth defects
• Hereditary diseases
• Frequent urinary tract infections (UTIs) of the kidneys or bladder

The most common cause of chronic kidney failure in teenagers is inflammation of the kidneys, a group of conditions called glomerulonephritis [gloh-MER-yuh-loh-nuh-FRAHY-tis].

Chronic kidney disease or kidney failure can also be brought on by another disease, such as lupus, that affects many organs in the body or by a condition that damages the kidneys, such as nephrotic [nuh-FROT-ik] syndrome. It may happen over months or years.

As the kidneys lose more and more function, your child’s diagnosis will be described in stages based on how much function is left. (This can’t be done for kids younger than 2.) Stage 1 is the earliest stage, and Stage 5 (or end-stage renal disease — ESRD) is the point at which your child will need a transplant or dialysis (a regular treatment to clean your child’s blood) to stay alive.

Your child’s care team will work to slow the progression of kidney disease and failure, and they will prepare your child for end-stage treatment.