Endocrinology
Children who suffer from kidney disease display different symptoms to adult patients. Here’s what you need to know.
Kidney disease occurs when the kidneys are unable to perform their vital function of filtering the blood. This means waste and fluids accumulate in the body over time, affecting the functioning of other systems in the body and giving rise to conditions like anaemia, high blood pressure, urinary incontinence and heart disease. Kidney disease in children can also lead to growth problems (many patients don’t to grow as tall as other children in their age group) or cognitive issues.
Unfortunately, says Dr Senzi Shazi, a paediatric nephrologist at Mediclinic Bloemfontein, “the most devastating thing about kidney disease is that it’s often insidious. It can be silent for a long time before the sufferer displays any symptoms.” In addition, when symptoms are present, they are typically non-specific and may appear to be related to other conditions. For example, poor feeding, fatigue and significantly slowed growth are key signs. Often, when an unborn baby has other congenital abnormalities, the condition is uncovered during a routine antenatal ultrasound scanning.
Red flags
There are other signs that may indicate that a screening for poor kidney function is advisable, Dr Shazi says. “Swelling is a common symptom. This is often confused with allergy, because the swelling is typically distributed around the eyes at first. However, it can progress to the stomach and legs.”
Parents should be alert to haematuria (or bloody urine), which may be painful for the child, while a frequent need to urinate could also be a symptom – especially if passing urine is painful, or if the urine is foul-smelling or foamy. “Foamy urine requires attention, because it may be a sign that there is protein in the urine,” Dr Shazi says. It’s also a good idea to look out for symptoms usually associated with urinary tract infections. These include pain (located in the side or back), fever and chills.
Acute versus chronic kidney disease in children
It’s also important to note that there is a difference between the symptoms of acute kidney injury (which lasts less than three months, and is usually reversible), and chronic, irreversible kidney damage tht has its roots in multiple causes.
“Acute kidney injury may be secondary to vomiting, diarrhoea, severe infections, other organ failure, medication and poisoning, or it may occur post-surgery,” Dr Shazi explains. Patients may present with signs of severe dehydration or shock secondary to loss of fluids. It is also common for young patients to stop passing urine, or to experience a decreased level of consciousness. Later on, they present with swelling which affects the face, stomach or entire body, after they stop passing urine. Convulsions, pulmonary oedema (wet lungs), an increased presence of acid in the blood (metabolic acidosis), a tendency to bleed and severe infection are other warning signs.
Chronic kidney disease, meanwhile, is indicated by poor growth or failure to thrive, along with failure to reach developmental milestones. Patients usually suffer recurrent urinary tract infections,” Dr Shazi adds, “They may also require frequent nappy changes because they are passing a lot of urine. This may lead to dehydration and constipation. Added to this, urine may be foul-smelling, and there is often a poor urinary stream, indicating a blockage.” Children may suffer fatigue because of low blood levels (haemoglobin) which presents as pale skin. They may also have severe headaches due to high blood pressure. Nausea and vomiting are common, along with skin pigmentation. Cramps are yet a further symptom, caused by low levels of Vitamin D, which cannot be activated by the kidneys. Heart failure may also result.
Expediting treatment
Dr Shazi says kidney screening is vital, as it enables early diagnosis of kidney disease and referral to a specialist if necessary. “The child will have their blood pressure tested, and will then have a urine dipstick to rule out infections and kidney disease.” Treatment will then depend on the underlying cause.