Endocrinology

Understand the causes of kidney disease in children and what factors could put your child at risk.

Globally, about 150 000 to 300 000 children experience kidney failure. The condition can be acute, lasting up to three months, or chronic. In children, kidney failure can be different: in some cases, it’s congenital (present at birth), while in others, it’s acquired (develops later), explains Dr Senzi Shazi, a paediatric nephrologist at Mediclinic Bloemfontein.

Genetic factors

Dr Shazi says genetics plays a significant role in the development of kidney disease in children. “In many cases, genetic mutations or abnormalities are common causes of congenital anomalies of the kidney and urinary tract (CAKUT), as well as conditions like nephrotic syndrome.” CAKUT refers to a group of abnormalities affecting the organs in the urinary system, including the ureters, bladder, urethra, and kidneys. The term covers several conditions, such as:

  • Hydronephrosis: Swelling of the kidneys due to a blockage preventing normal urine flow.
  • Vesicoureteral reflux: A condition where urine flows backward from the bladder into the ureters and kidneys.
  • Dysplastic kidneys: When the kidneys do not develop properly while in the womb.
  • Multi-cystic dysplastic kidneys: Abnormal kidney development during pregnancy.

Genetics plays a significant role, especially with a family history of kidney disease, hypertension, early-onset diabetes (before age 40), hearing loss, or haematuria (bloody urine). A history of kidney transplant or failure is also a risk factor, says Dr Shazi.

The impact of maternal wellbeing during pregnancy

Not all kidney failure cases are genetic. Dr Shazi notes that a mother's health during pregnancy can also play a role. “There is a higher risk that a child will develop kidney failure if the mother experienced hypertension during pregnancy, or had diabetes mellitus or infections during pregnancy,” she says. Children of mothers with lupus are also at risk.

Exposure to substances during pregnancy can increase the risk of kidney failure in children. This includes illicit drugs, alcohol, and certain medications like ibuprofen, aspirin, some antiepileptics, and antidepressants.

Red flags for kidney disease in children

Dr Shazi says the risk of kidney disease also increases for pre-term babies, because their kidneys have not yet had time to develop properly. “We see a greater incidence of kidney failure among babies that had a low birth weight, typically below 2.5kg,” she reports.

Babies with low Apgar scores at birth – used to assess heart rate, reflexes, and muscle tone –may be at risk for kidney disease. A low score can signal neonatal encephalopathy, a condition caused by a lack of oxygen during birth that can affect the brain and other systems, including the kidneys. Doctors will also keep a close eye on babies who had a catheter insertion into the umbilicus during the first 28 days of life, Dr Shazi says.

“Other factors which may indicate that a patient is at risk include having a single kidney – whether the other kidney has been removed surgically or was absent at birth – or being admitted to an ICU with kidney damage. It’s vital that any child who appears to be at risk is screened for kidney disease as soon as possible, as this expedites treatment and referral.”

To find a paediatric nephrologist near you, go to www.mediclinic.co.za