KNOW YOUR KIDNEY
The kidneys are bean-shaped organs, located just below the rib cage on each side. The whole urinary tract includes kidneys, ureters, bladder and urethra. Ureters are the thin tubes of muscles which carry urine from each of the kidneys to the bladder.
Every day, the kidneys filter about 120 to 180 L of blood with the normal Glomerular filtration rate (GFR) above 90 ml/min/1.73 m2. Other than water balance, kidneys maintain electrolytes, acid- base balance in the body and reabsorb many important filtered substances such as proteins and glucose etc.
It also produces hormones like erythropoietin which is responsible for maintaining hemoglobin (deficiency leads to Anemia) and active Vitamin D for maintaining stable calcium & phosphorous levels (healthy bones).
Any anatomical defect of urinary tract, local or systemic infections, immunological and genetic causes affect children in various ways, ranging from treatable disorders without long-term consequences to life-threatening conditions. Kidneys are often involved in both localized and systemic infections. Certain conditions cause excessive urine formation and other very less urine, both need observation and treatment.
How to Test Urine Protein at Home By Dipstick
Fill a sterile specimen container with urine. Urinalysis tests should always be conducted using fresh urine
Dip the test strip into the urine. Take hold of the gripping surface at the thick end of the dipstick
Compare the test squares to the color chart Bottle has test strips to look and see color chart for easy analysis
Common Childhood Kidney Diseases
Urinary tract infections
(UTI) are easy to diagnose in older children and adults but difficult in infants with vague symptoms. Symptoms include frequent, painful, burning urination; fever and urine may appear cloudy or bloody. When infection reaches the kidneys then back pain and high-grade fever may also occur. For UTI, a urine sample is taken to check for bacterial growth. If the child is given antibiotics, relief usually begins within 12 to 24 hours. If the UTI affects the kidneys, hospitalization, and intravenous medications are usually required.
When urine goes back up from the bladder to the kidney then it is termed as reflux. Vesico-ureteric reflux often diagnosed after UTI or even without symptoms after his birth with congenital defect (persisting pelvis and ureteric dilatations). This is due to a defect of the “valves” between the ureters and the bladder and diagnosed by voiding cysto-urethrogram (MCU).
Nephrotic Syndrome
Child present with sudden onset swelling over face, eyes, and body and will have significant urinary protein. It can appear with or without upper respiratory tract infection symptoms. Diagnosis needs confirmation with the persistence of low albumin and high cholesterol levels in the blood investigations and documentation of high urinary protein. Although the commonest affected age group is 3-4 years, but we also often see kids beyond this age group. Age of onset also determines the severity and response to treatment. When presents in an infant of less than three months of age (congenital nephrotic syndrome) then support with albumin transfusion & diuretic treatment as and when required. Congenital nephrotic syndrome is often associated with the genetic mutations. For Nephrotic syndrome, beyond this age group, oral steroids are the mainstay of treatment, which are prescribed after documenting no hidden underlying infection. When it does show response to steroid therapy then kidney biopsy is needed which should be done by a pediatric nephrologist
GLOMERULONEPHRITIS
Presentation with mild to moderate swelling, decrease in urine output, and presence of protein and RBC in the urine. It can be associated with rash, fever, or other systemic symptoms depending on the underlying cause of the disease. Such causes can vary from SLE and other autoimmune and collagen disorders, Vasculitis, HUS, and many bacterial and viral infections. Urgent attention is required to prevent acute or chronic kidney injury and timely initiation of treatment.
ACUTE KIDNEY DISEASE
Fall in urine output or no urine output and deranged kidney function occurring suddenly with or without any insult, lasts a short time, and can be serious with long-lasting consequences or may go away completely once the underlying cause has been treated. Acute kidney disease may require dialysis therapy for a short duration.
PEDIATRIC KIDNEY TRANSPLANT
Childhood dialysis and transplant can be done with pediatric nephrologist, who take care of all aspect related to the disease. Children with CKD or kidney failure face many challenges need great family support to avoid a negative self-image, behavior problems, learning problems. It can trouble child in concentrating, delayed language skills development, and delayed motor skills development. Children with CKD may grow at a slower rate than their peers.
CHRONIC KIDNEY DISEASE
Does not go away with treatment and tends to get worse over time. CKD leads to kidney failure and requires a kidney transplant or blood-filtering treatments called dialysis.
Parental support and counseling are very important for the need to understand the importance of adequate dose, duration, and side effect of steroid therapy. A child needs to take prescribed medicine regularly as per the treatment advised. Also need to maintain a diary for regular urine protein monitoring at home by uristix.
Hypertension
Children can also have high blood pressure as adults and need medications. As causes are variable so proper evaluation should be done alone with the management of blood pressure.
Prevention of UTI
Maintain follow up if suffering from any chronic kidney disease and understand it from your doctor to avoid any suffering and emergency
Childhood Dialysis
Hemodialysis, peritoneal dialysis, CRRT (continuous renal replacement therapy), Plasma exchange therapy Kidney transplantation.
How you can care and prevent kidney diseases
Drink enough water as per change in temperature and body need.
Avoid taking frequent medications such as pain killers, pantoprazole and consult doctors before having such medications
CAKUT
(Congenital Abnormality of Kidney and Urinary tract) are the most common of causes of chronic kidney disease in children. Causes can vary from pelvis swelling (hydronephrosis) to single kidney, multicystickidney, Polycystic Kidney.
Diagnostic and treatment modalities for childhood kidney disease includes
Ultrasonography, Renogram (for obstructive or non-obstructive kidney disease), VCUG & DMSA (for reflux & Kidney scars due to infection), Kidney biopsy.