When Your Child Has a Chronic Kidney Disease

Treating Kidney Diseases

Treatment begins with diet modification and medicines. Your child may need to take several medicines, including vitamins, calcium, bicarbonate, and blood pressure pills. As a result, medication management can be a major challenge.

If your child has difficulty remembering to take medications, consider getting a medicine clock, which has two cardboard clocks — one for each 12-hour period — with a picture of the medicines posted on the the times they need to be taken. These clocks can provide valuable cues for kids who need to take several doses of different medicines throughout the day and evening. Also, alarm watches can be set to remind kids to take their medicine.

If your child must take so much medicine that it affects his or her appetite, contact your doctor for advice. Try to find the most acceptable forms of medicine (smaller pills, capsules, or more concentrated liquids, for example) and simplify the medication schedule under your doctor's guidance.

Newer injectable medicines are available for treatment of anemia and growth failure in some kids with chronic kidney disease. Erythropoetin can increase the red blood cell count, which often improves energy and activity levels in kids with kidney failure. Recent studies have shown that many kids with chronic kidney disease will grow more normally with the help of human growth hormone injections.

Children with chronic kidney failure may not have any symptoms until about 80% of their kidney function is lost. Then, they may feel tired, have nausea or vomiting, have difficulty concentrating, or experience confusion. Accumulated fluid appears as swelling in the skin, fluid congestion in the lungs, and high blood pressure. At this stage, two treatment options are available — dialysis and transplant.

Dialysis

Nearly all kids with end-stage kidney disease eventually receive transplants. If a living related donor can't be found, dialysis may be required until a donor kidney becomes available.

The two forms of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, blood is cleansed outside the body through a machine. These treatments can take 4 hours at a time and need to be performed two to three times a week. In general, diet restrictions are less strict with peritoneal dialysis, and children tend to grow better. Both types of dialysis, but particularly hemodialysis, require that diet be limited with regard to fluids, phosphorus, and salt intake.

Peritoneal dialysis uses the body's own peritoneal membrane — beneath the outer layers of the abdominal wall — to filter the blood. It requires fewer dietary and fluid restrictions and offers more lifestyle flexibility.

Two forms of peritoneal dialysis are available:

1. continuous cycling peritoneal dialysis, or CCPD
2. continuous ambulatory peritoneal dialysis, or CAPD

CCPD uses a simple machine to perform the dialysis at night; CAPD is done throughout the day. CCPD requires the assistance of a parent and is most suitable for younger children; CAPD is performed by the patient and may be more suitable for older kids and teens.

Helping Your Child

Needs of kids with chronic kidney disease often include dietary changes. Ensuring that they get adequate calories and proper amounts of various nutrients can be a challenge. Supplementing your child's diet with extra carbohydrates and fats might help to increase calorie intake.

The kidneys cannot easily remove excess water, salt, or potassium, so their intake might need to be limited. Dairy products have to be restricted because they contain large amounts of phosphorus. Too much phosphorus may lead to calcium deposits in the eyes, heart, skin, and joints and may leach calcium from bones, which can increase the risk of broken bones.

But eliminating dairy foods can make it difficult for kids to get enough calcium to maintain bones and support other body functions, particularly those affecting growth.

In kids with more severe kidney failure, reducing the intake of dairy products and other protein-rich foods (such as meat, fish, or eggs) can make the filtering work of the kidneys easier and can sometimes delay the need for dialysis. While avoiding excessive protein intake is advisable and will also help limit phosphorus intake, it's important to remember that kids do need enough protein for growth — so strict protein restriction (the kind recommended for adults) should not be used.

You'll also need to monitor fluid intake. If your child's ability to produce urine is declining, fluid intake needs to be limited. Stay away from "super-size" drinks, and offer slushy beverages or ice cubes to suck on.

Some kids with kidney disease, particularly those with high blood pressure, may need to restrict their intake of sodium, which is found in table salt and many foods. Be careful of salt substitutes, too. Many salt substitutes have potassium in them, which can cause renal failure. Some other salt preparations (for example, "natural salts," Himalayan salts, etc.) are just as high in sodium chloride as common table salt.

Read food labels and talk to your doctor or a dietitian about the sodium content of various foods. Consult your nephrologist about an appropriate diet that meets your child's need for calories and nutrients while minimizing damage to kidneys and avoiding other complications.

Exercise will help your child perspire to get rid of excess fluid and flush out toxins through the skin. Keep TV and video games to a minimum and encourage physical activity instead. Walking and strength training make bones stronger and stimulate muscles and nerves that can help ease "restless leg syndrome" and other nervous system problems sometimes associated with kidney disease.

Helping Your Child (more)

Beyond these physical concerns, kids should be encouraged to express their feelings. Try to find well-adjusted young adults who had chronic kidney disease during childhood to talk with you and your child. You may find contacts and support groups through your nephrologist or the National Kidney Foundation. It's important for kids to see that the symptoms of the disease can be managed and controlled and that they can live a full life.

Kids whose health is stable should be encouraged to participate as fully as possible in school and activities, which will help them develop their self-esteem.

During hemodialysis treatments, doing homework, reading, and working on art projects are some positive ways to spend the time. (One pediatric dialysis patient said she appreciated the special lunches her mother prepared before her treatments, when she could ease up a little on the protein, sodium, and potassium restrictions.)

As kids with chronic kidney diseases get older, they can take on more responsibility for their own care. School-age kids should know the names of their medicines and how and when they're taken. As they're making the transition to adulthood, teens can share in the responsibility of making appointments. Teens should also have time alone to speak with the doctor and other members of the health care team.

A big step for kids is being able to talk to others — such as teachers, coaches, and friends — about their condition. Teens especially don't want to stand out or seem different. Part of the process of learning and maturing will be identifying limitations and knowing when to ask for help.

Kids with chronic kidney disease might also have problems dealing with the side effects of medicines. For those taking prednisone for long periods of time, these effects can be significant, including weight gain (especially around the face and trunk), moodiness, sleep disturbances, cataracts, and osteoporosis (weakening of the bones). Long-term treatment with these medications also can slow growth and delay pubertal maturation.

Long-term prednisone treatment can lead to or aggravate acne in teens. To an adolescent dealing with body image, a clear complexion might be just as important as controlling the kidney disease.

Besides the stress of having a chronic illness, your child is going through all of the trials and tribulations of growing up as experienced by all kids. Treat him or her as a child first, which includes establishing standards of behavior. Sometimes, those standards have to be relaxed or suspended during particularly difficult times; the trick is picking them up again after your child's health improves.

Keep the lines of communication open so everyone knows what's happening and never hesitate to ask for help from your doctor or a mental health professional if you think it might be needed.

Reviewed by: Laszlo Hopp, MD
Date reviewed: March 2009