What to do with a diagnosis of CKD in children?
Although nephropathies are mainly associated with older people, there are also cases where children suffer from them. Understanding this diagnosis can provide tools for parents of these children to provide informed guidance on the health of their children. For this reason, we spoke with Angélica Calderón, nephrologist of Baxter RCS, who answered five key questions about nephropathy.
What are the diseases that cause kidney damage in children? And how common are they?
When kidneys do not work properly, we talk about kidney injury, and in sever cases, renal failure. In the last one, permanent damage is described as chronic kidney disease. Kidney injury may occur from the formation of the kidneys during gestation. In the first days of life they will manifest with symptoms in the newborn, or in the following months of life. These alterations or malformations in kidneys can be diagnosed with obstetric ultrasound or detailed ultrasound performed in prenatal checks by obstetricians-gynecologists; thus we anticipate the congenital alterations of the urinary tract, and in this way an intervention is achieved in time to avoid the deterioration and permanent damage of the kidneys, which are vital organs in the growth and proper development of the child.
Among the most frequent congenital malformations we have hypoplasia, renal dysplasia, renal agenesis, obstructive uropathies and vesicoureteral reflux nephropathy; in children born by premature birth (preterm newborn)requires strict monitoring for the risk of future kidney injury, Since the formation kidneys is completed in the 36th week of gestation and by not completing this nephrogenesis the limitation of functional cells of the kidney will happen, this requires future controls for your kidneys to be in an optimal condition in adulthood.
Other alterations that can generate renal damage are cystic kidney disease; glomerulopathies that require medical study and management, as well as bacterial infections, poisoning, heart disease, heart failure and drug overdose can lead to acute renal failure. But if it is not properly managed, it can lead to chronic kidney disease that leads the child to require dialysis and kidney transplant.
With regard to how frequent chronic renal disease is in the pediatric patient, some European registries show incidences around 10-12 patients per million in the pediatric population, with a prevalence around 59-74 patients per million in the pediatric population, for this reason it is priority to act in prevention to project a healthy adult with fewer comorbidities.
What recommendations would you give to parents facing a diagnosis of chronic kidney disease in their children?
The first step is to periodically consult your pediatrician. It is important to attend the controls with pediatric nephrology to guide the comprehensive management of the pathology, making a physical, nutritional and emotional approach that allows us to be attentive to any change, performing interventions in time to avoid further deterioration of renal function. Working with your pediatrician, you will identify other risk factors that may influence the failure to improve or stabilize your kidney disease.
Also, it is recommended not to stop the monitoring and medication indicated by your treating pediatric nephrologist.
Also, parents should inform their pediatric nephrologists if they are administering any supplements or medicinal herbs, as these can accelerate kidney damage.
Warning signs to consult at a priority level the emergency services
• Fever that does not improve with physical means or doses indicated by doctors for managing hyperthermia for more than 24 hours
• Edema or swelling around the eyes, face, feet, and ankles
• Burning or painful urination
• Unbearable lumbar or abdominal pain
• Increase in urinary frequency
• Urinary incontinence
• Changes in urine characteristics: urine with blood, foam or fat
• In monitoring blood pressure figures, they may find them higher, associated with symptoms of headache, vomiting, or changes in behavior, abnormal movements, or loss of consciousness.
• Absence or difficulty urinating in 24 hours
What nutritional recommendations would you give to children with chronic kidney disease?
In the patient with kidney injury, the first recommendation and one of the most important is the consumption of a low sodium diet (maximum 1 gram of sodium per day).
The diet should be free of processed food, with this we mean nothing bottled, sausages, canned, cereal box (very fashionable in the diet of children at this time) because if we are good observers and readers of the nutritional table of this type of products, in their records report sodium contents generally exceed 10-15%. The idea is not to abuse sodium in the diet because of changes in renal physiology that have an impact on accelerating kidney damage.
The patient should eat a diet rich in fruits and vegetables. Regarding animal and vegetable protein in conjunction with the nutrition team, recommendations are made according to their renal failure state, in order to achieve a balance without generating alteration in the weight gain and height of our patient.
Finally, it is recommended to avoid supplements or vitamins, herbs or medicinal plants on your initiative; please always consult with your doctors.
How to link nutritional recommendations with the socio-cultural reality of pediatric patients and their families?
I always tell my patients that on this healthy journey to maintain kidney health we must adopt strategies in the family that must be very loving and intelligent in order not to see it as a restrictive and/or expensive diet. On the contrary, they are invited to experiment with flavors and foods that fortunately in our country are abundant. It should be kept in mind that fruits and vegetables are more economical, we can alternate the consumption of vegetable protein with animal protein, and as we connect with good habits, our habits are modified to adapt to the changes that are reflected in maintaining kidney health, avoiding reaching dialytic therapy or kidney transplant early.
What physical activity recommendations do you recommend for children with chronic kidney disease?
Physical exercise is very important in children. The idea is to strike a balance between aerobic exercise, strength and flexibility. But it all depends on the patient’s age and commitment to the condition of chronic renal failure.
Children should be physically active outdoors, exposed to sunlight for at least 15 to 20 minutes in order to improve serum levels of vitamin D, which is fundamental in the bone health of the patient with kidney disease.
In adolescents, the recommendation is to perform physical activity if their conditions allow, between 40 and 60 minutes in the day, but this physical activity should be directed by their specialist according to their physical and mental conditions.