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What Is Pediatric Kidney Disease?

Pediatric kidney disease refers to chronic kidney disease (CKD) in children. It occurs when a child has kidney damage that persists for at least three months. Your child’s kidneys can’t effectively remove waste from the blood and perform other jobs as well as they should.

CKD is a long-term, progressive disease, which means it gradually worsens over time. If kidney failure occurs, a child will need dialysis or a kidney transplant. Kidney failure is also known as end-stage kidney disease or end-stage renal disease (ESRD). “Renal” means related to the kidneys.

What Do the Kidneys Do?

Most children are born with two kidneys. Less commonly, a child is born with one kidney — a congenital condition called renal agenesis. Kidneys perform many critical functions. These organs:

Filter and remove waste and excess water from the blood
Help make red blood cells, which carry oxygen
Keep blood pressure in a healthy range
Maintain a healthy balance of calcium, potassium, sodium and other electrolytes

What Causes Pediatric Kidney Disease?

Different conditions can cause CKD in children. Common causes include:

Congenital anomalies of the kidneys and urinary tract (CAKUT)

Congenital anomalies of the kidneys and urinary tract (CAKUT) are present at birth. These types of birth defects are more common in boys but can affect girls too.

Types of CAKUT include:

Fetal multicystic dysplastic kidney (MCDK)
Posterior urethral valves (PUV)
Renal dysplasia (hypoplasia)
Ureteropelvic junction (UPJ) obstruction
Vesicoureteral reflux (VUR)

Genetic kidney diseases

Some children inherit gene changes (mutations) that cause inherited kidney diseases. Children of African ancestry are more likely to carry changes in the APOL1 (apolipoprotein L1) gene that can increase the risk of kidney disease.

Other types of genetic kidney diseases include:

Alport syndrome
Bardet-Biedl Syndrome (BBS)
Polycystic kidney disease (PKD)

Glomerular diseases

Glomerular diseases are a type of structural kidney disease. These conditions damage tiny filters in the kidneys called glomeruli that help remove waste and fluids from the blood. This damage can lead to nephrotic syndrome, which causes protein loss in the urine and swelling.

Types of glomerular diseases include:

Focal segmental glomerular sclerosis (FSGS)
Glomerulonephropathy and glomerulonephritis
Lupus nephritis (serious complication of lupus)

What Are the Risk Factors for Pediatric Kidney Disease?

Risk factors for pediatric kidney disease include:

Diabetes
Family history of kidney disease, especially genetic (inherited) diseases
High blood pressure (hypertension)
Obesity
Preterm birth, before the 37^th week of pregnancy
Recurrent urinary tract infections (UTIs)

What Are the Stages of Chronic Kidney Disease?

Kidney disease progresses in stages. A blood test to measure the estimated glomerular filtration rate (eGFR) can show how well the kidneys are working. The eGFR number and other signs of kidney damage determine the disease stage.

Stage 1: Slight damage, but normal kidney function (eGFR of 90 or higher)
Stage 2: Mild damage (eGFR between 60 and 89)
Stage 3a: Mild-to-moderate damage (eGFR between 45 and 59)
Stage 3b: Moderate-to-severe damage (eGFR between 30 and 44)
Stage 4: Severe kidney damage (eGFR between 15 and 29)
Stage 5: End-stage kidney disease or kidney failure (eGFR below 15)

What Are the Signs and Symptoms of Pediatric Kidney Disease?

A child with early-stage kidney disease may not have symptoms. Symptoms typically become more noticeable as the disease progresses and the kidneys struggle to do their jobs. Signs of CKD in children include:

Failure to thrive (poor growth)
Fatigue
Foamy-looking urine
Frequent urination, including bedwetting
Headaches
Nausea, loss of appetite and/or vomiting
Pink or tea-colored urine caused by blood in urine (hematuria)
Swelling (edema) in the hands, feet, legs or face

What Are the Complications of Pediatric Kidney Disease?

Kidney failure, which is life-threatening, is the most serious complication. But kidney disease also puts your child at risk for:

Anemia
Bone problems, including low bone density (osteoporosis) and broken bones
Developmental delays
Electrolyte imbalances, such as high potassium (hyperkalemia)
High blood pressure
Parathyroid disorders, such as secondary hyperparathyroidism
Stunted growth

How Is Pediatric Kidney Disease Diagnosed?

Tests to diagnose chronic kidney disease in children may include:

Blood tests to measure waste products (creatinine), proteins and electrolytes, which help determine kidney function and stage
Urine test (urinalysis) to look for blood and protein in urine
Imaging tests, such as an ultrasound, MRI or CT scan, to look for congenital anomalies, blockages and other urinary system issues
Genetic screening to test for an inherited kidney disease
Biopsy of kidney tissue to check for kidney damage

Advanced Diagnostic Tests

Your child may also need these tests:

MAG3 scan (renogram), a type of nuclear medicine test that evaluates kidney function and can help identify blockages (obstructions)
Voiding cystourethrogram (VCUG) to see if urine flows back into the kidneys (vesicoureteral reflux or VUR)

How Is Pediatric Kidney Disease Treated?

Pediatric kidney disease doctors (nephrologists) at Lurie Children’s provide compassionate care for children with all types of kidney disease. While there isn’t a cure for CKD, treatments can slow kidney damage, ease symptoms and support your child’s growth and development. We customize a treatment plan for your child’s unique diagnosis.

Treatments may include:

Dietary changes to limit phosphorus, potassium, sodium and other minerals that are hard for the kidneys to filter
Growth hormones to help your child grow
Medications to treat anemia and blood pressure, support bone growth and health, reduce protein in urine and remove excess water from blood

Kidney Failure Treatments

Children who develop kidney failure need some type of kidney replacement therapy, such as:

Dialysis to remove waste and fluid from blood and perform other kidney functions
Kidney transplant to replace a diseased kidney with a healthy organ from a living or deceased donor

What Is Lurie Children’s Approach to Caring for Children With Chronic Kidney Disease?

The Pediatric Kidney Disease (Nephrology) Program at Lurie Children’s ranks among the country’s top 10 programs, as recognized by U.S. News & World Report. We’re home to the region’s largest pediatric nephrology care team. Your family benefits from:

Dedicated program: We refer children with stage 3b kidney disease and higher to our Guidance & Planning in Advanced CKD (GAP) Program. Specialists educate your family about kidney failure treatment options, including dialysis and transplantation, helping you make the best choice for your child when the time comes. Early referral allows time to plan, with the goal of preemptive transplant when possible. Your child receives a kidney transplant before they would need dialysis.
Full range of dialysis options: Our Acute Dialysis and Pheresis Therapy Program (ADAPT) is the largest inpatient pediatric dialysis unit in Illinois. We partner with DaVita hemodialysis centers for outpatient needs. We also provide training and care for children who receive peritoneal dialysis, which takes place at home.
Exceptional kidney transplant outcomes: Our Pediatric Kidney Transplantation Program is the largest in Illinois and among the top three nationally for transplant volumes. We transplant kidneys from deceased and living organ donors with exceptional outcomes.
Genetic kidney disease experts: Experts at our Kidney Genetics (Nephrogenetics) Program support families with inherited kidney diseases. Our specialists can help you understand how a condition may affect your family and future generations.
Support for teens and adults: Teenage kidney transplant recipients can easily make the transition to adult services through our partnership with the Kidney Transplantation Program at Northwestern Medicine. This partnership also ensures adult living kidney donors can easily access the services they need.
Team approach: Depending on your child’s unique needs, they may also receive care from specialists in cardiology, urology, bone health, diabetes, nutrition and other fields.
Evidence-based care: We’re active in global research studies and clinical trials, including the Chronic Kidney Disease in Children Study (CKiD), Cure Glomerulonephropathy (CureGN) consortium and North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS).