A Glimpse On Chronic Kidney Disease - Dr. Sidharth Sethi

1. A Glimpse On Chronic Kidney Disease- Dr. Sidharth Sethi • CKD (chronic kidney disease) is a lifelong condition in which the kidney function slowly declines over many years. It is common in adults but extremely rare in children. It can be caused by a number of conditions affecting the kidney and can present at birth or later on during childhood. All kidney conditions do not cause CKD and all kids with CKD do not always progress to the end stage. It is a complicated disease with a wide spectrum from which full recovery is not possible but timely specialist care can help your child live a long, healthy and wholesomelife. • How Would Ckd Affect My Kid’sLife? • In the early stages (1,2,3), most children do not have any symptoms although they might have small shrunken kidneys on imaging or loss of protein in their urine(proteinuria). • In late stages (4,5), the kidneys function worsens and your child may develop any of the following- • FEELING OF ILL-BEING– Your child may lose his appetite, have nausea/vomiting and feel lethargic. • CHANGES IN URINATION- Some kids cannot produce concentrated urine and they pass large amounts of weak urine (almost with all water and few wastes). They often drink lots of water to make up for thisloss. • Other kids are unable to form much urine and passlittle. • FLUID OVERLOAD– When kidneys don’t make enough urine, water and salts build up inside the body and cause swelling(edema) in various parts of thebody. • ANEMIA- The child looks pale and tired because of reduced hemoglobin, which is an oxygen carrying molecule inside red blood cells (RBCs). This happens because kidneys no longer produce sufficient amount of a substance called erythropoietin which helps in forming RBCs. • BONE DISEASE-Bones become less strong and may fracture. The child canalso • develop rickets (soft, weak, painful bones) and many bony deformities (bowed legs, curved spine). This is because kidneys are unable to activate vitamin D and maintain normal levels of calcium and phosphate in theblood.

2. CHANGES IN ELECTROLYTES- Electrolytes are important chemicals needed for healthy body function. In CKD, their levels become abnormal (as kidneys do not function properly) and can resultin- • High sodium causes fluid overload and hypertension (↑ bloodpressure). • High potassium causes muscle weakness and cardiac arrest (heartattack). • High phosphate and low calcium cause bone disease and musclecramps. • Low bicarbonate causes a rise in acid levels and low bloodpH. • CARDIOVASCULAR DISEASE– Children with CKD are at risk of developing diseases of heart and blood vessels which might cause sudden death. This can be dueto- • Hypertension • Stiffening of blood vessels due to calciumdeposition • Cardiac fibrosis (replacement of normal heart substance with scartissue) • Cardiac arrhythmias (disordered heartbeating) • What Tests Would My ChildUndergo? • Your pediatrician would run the following battery of tests for further treatment of yourchild. • 1.BLOOD TESTS– A blood sample would be obtained to checkfor- • GFR-This can be estimated by measuring creatinine levels or by specific techniques using radioactive chemicals. [NormalGFR>90mL/min/1.73m2] • Electrolyte, protein,sugar,cholesterollevels • Urea and creatinine (waste substances produced inbody) • Complete blood count (foranemia) • PTH[(parathormone); tells severity of bonedisease] • URINE DIPSTICK– A paper strip impregnated with a chemical which will change color when dipped into a urine sample containingprotein/blood. • IMAGING TESTS- • Ultrasound scan– A safe hand-held device emits sound waves and visualizes the kidneys on the screen. • MCUG/VCUG-This test detects VUR. A dye is injected into the bladder via the urethra and serial X-rays are taken when your childurinates.

3. MAG-3 scan-This test tells us about kidney function. A chemical is injected into a blood vessel after which a special camera takes pictures showing how much blood gets in and out of the kidneys, and how well kidneys are drainingurine. • DMSA scan– This test looks for any structural damage(scars) in the kidneys. A chemical is injected in the blood and images of urinary tract are taken by acamera. • CT scan-Your child would lie on a bed that moves into a tunnel where multiple X-ray images are taken at various angles. 4.RENAL BIOPSY– A small piece of your child’s kidney obtained with a needle is seen under a microscope to find out the exact cause of CKD. Special medicines given at the time of biopsy would make your child sleep so that he/she feels nopain. • How Would My Child BeTreated? • Your child will require specialized medical care from a pediatric nephrologist. It is important that you regularly visit the clinic for follow-up appointments even if your child feels well. At eachof • these visits, the growth(height,weight) and kidney function of your child would be monitored to avoid any future complications. The medical treatment aimsat- • Reducing blood pressure [by low salt diet andmedicines] • Slowing protein loss in the urine [by medicines like ACE-I(angiotensin converting enzyme inhibitor) or ARB(angiotensin receptorblocker)] • Avoiding bone disease [by calcium and vitamin D supplements] • Controlling anemia [by erythropoietin supplements or blood transfusion] • Healthful living- • Ensure that your child eats at least five servings of fruits and vegetables a day. Cut down on his/her sugar and fatintake. • Get him/her plenty ofexercise. • Avoid taking common medicines like ibuprofen/diclofenac without higher supervision as they cause further kidneydamage. Many children with progressive disease who develop ESRD would ultimately need dialysis, which uses special equipment to remove waste products and extra water from their body. The best treatment is a kidney transplant, in which a healthy kidney from another person is transplanted into the child. After a successful kidney transplant, the child can live a healthy life, but will need to take medicines to look after the newkidney.