Kidney disease in Children : 10 Commandments

Dr Sanjeev Gulati *

The posterior surfaces of the kidneys, showing areas of relation to the parietes. :: Pix - Wikipedia

1. Kidney disease can occur at any age in children from new born to adolescents
2. A good ante natal ultrasound can detect can detect majority of the kidney diseases in newborns
3. Urinary tract infections is one of the commonest preventable forms of cronic renal failure in children.
4. All children with unexplained fever should be screened for UTI
5. All children with UTI should be investigated in detail fro underlying urinary tract malformations
6. Acute Kidney Injury should be promptly diangnosed and treated. Otherwise a significant number of these children will die or progress to chronic Kidney Disease.
7. The symptoms of Chronic Kidney disease may be subtle and non specific like :Hypertension or anemia or failure to thrive.
8. Early Diagnosis of CKD in children can add yers to life as well life to years of these children.
9. EGFR estimation is he most accurate method of diagnosis and staging CKD in Children
10. Kidney Transplantation is the optimal modality of treating children with Stage V CKD.

Kidney Disease - facts and fiction
Kidney Disease - No time to kid

There is an an increasing prevalence of kidney disease all around the world and also in our country. You have two kidneys, each about the size of your fist. Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. However Kidneys do much more than that.

What do kidneys do?

The kidneys are powerful chemical factories that perform the following functions:
* remove waste products from the body
* remove drugs form the body
* balance the body’s fluids
* release hormones that regulate blood pressure
* produce an active form of vitamin D that promotes strong, healthy bones
* control the production of red blood cells

What is Chronic Kidney Disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease.

Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

One in ten Indians has Chronic Kidney Disease and another 20 million more are at increased risk.
* Early detection can help prevent the progression of kidney disease to kidney failure.
* Heart disease is the major cause of death for all people with CKD.
* Glomerular filtration rate (GFR) is the best estimate of kidney function.
* Hypertension causes CKD and CKD causes hypertension.
* Persistent proteinuria means CKD.
* High risk groups include those with diabetes, hypertension and family history of kidney disease.
* Three simple tests can detect CKD: blood pressure, urine and serum creatinine.

Many people with Kidney Disease are still in the dark. Nearly half of people with an advanced form of kidney disease do not know they have weak or failing kidneys, according to recent research published in the American Journal of Kidney Diseases. When it comes to diagnosing and determining the best diagnostic test measuring glomerular filtration rate, or GFR, is the most accurate way to diagnose kidney disease.

GFR is also the best tool to gage a patient’s stage of disease, enabling doctors to plot out the most appropriate course of treatment. In other words, knowing your GFR can save your life. Everyone who is at risk of kidney disease must get their GFR checked on a regular basis.

GFR — The GFR tells you how well your kidneys are filtering blood. You can’t raise your GFR. The goal is to keep your GFR from going down to prevent or delay kidney failure.

See the dial picture below.

* A GFR of 60 or higher is in the normal range.
* A GFR below 60 may mean kidney disease.
* A GFR of 15 or lower may mean kidney failure.

Who are the people at high risk of Chronic Kidney Disease?

Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you:
* have diabetes
* have high blood pressure
* have a family history of chronic kidney disease
* are older
* belong to a population group that has a high rate of diabetes or high blood pressure, such as Indians.

What Are the Warning Signs of Kidney Disease?

1. High blood pressure
2. Protein and/or blood in the urine
3. Creatinine and BUN blood tests outside the normal range*
4. Glomerular filtration rate (GFR) of less than 90**
5. More frequent urination, particularly at night; difficult or painful urination
6. Puffiness around eyes, swelling of hands and feet

Is Kidney Disease treatable?

Yes in its early stages kidney disease can be treated very effectively. People with CKD often take medicines to lower blood pressure, control blood glucose, and lower blood cholesterol. Two types of blood pressure medicines—ACE inhibitors and ARBs—may slow CKD and delay kidney failure, even in people who don’t have high blood pressure. Many people need to take two or more medicines for their blood pressure. They also may need to take a diuretic (water pill). The goal is to keep your blood pressure

When is dialysis / transplant required ?

Once the estimated kidney function (GFR) declines to less than 30 mL/min per 1.73 m2, it is time to start preparing the patient and the family for dialysis o kidney tarnsplant. This will be needed when the eGFR falls below 10-15 ml/min.

What can we do to prevent kidney disease ?

The key to preventing kidney disease is awareness of the common risk factors causing this condition and to ensure blood pressure and blood sugar control.we should all get into the habit of getting an annual health check up just as we send our car for servicing at a garage. After all “ Prevention is better and easier than cure”