How safe is your child from pediatric kidney conditions?

Like many non-communicable diseases, kidney complications were for long regarded as ‘diseases for the old’. In the past, it was also rare to find young people complaining about abdominal pain caused by damage of the internal organs. But times have changed for the worst, leaving both the old and young weeping over kidney diseases. Dr Joseph Ntarindwa, a urologist with the Africa Healthcare Network, says that it is no longer surprising that young people are falling victim of kidney diseases. Between December last year and February this year, out of the 10 cases the kidney specialist diagnosed positive for kidney disease, only one was an adult. Some were acute, while others had chronic cases. “Predominant cases of kidney malfunctions in children are of the acute type,” he says. It is said that some acute cases disappear after some time for the kidney to recover full functionality but that is not always the case as some persist causing permanent damage to the victim. But what causes such damage in children? Causes of kidney disease The causes of kidney damage are many, but in children malaria and genetic factors are known to be one of the main causes. Other causes include hypertension, diabetes, hepatitis B and C. These are risk factors towards chronic kidney damage. However, there is also a high possibility that kidney problems can be passed on from one generation to the other. “Common in the Rwandan population is autosomal dominant and autosomal recessive conditions. Unless identified early they are serious predisposing factors for severe kidney damage. Enlargement of the organs that usually requires transplant also results from genetic cysts,” adds Dr Ntarindwa. More causes of kidney complications include soar throat and skin sepsis. When subjected to such complications, the ultimate work of kidneys in compromised. How kidneys work Normally, kidneys have a similar role in both children and adults. Kidneys act as the body’s sieve for garbage collection and disposal which happens in microscopic units called nephrons. It is here that the kidneys remove waste products and extra water from the food a person eats. However, some times certain chemicals such as sodium, phosphorus and potassium may be returned to the bloodstream to establish a balance. During the process of ultra filtration, the surplus water that combines with other waste becomes urine, which flows through thin tubes called ureters to the bladder, where it stays until it exits through the urethra. The kidney is also responsible for the production of three important hormones - erythropoietin, which stimulates the bone marrow to make red blood cells; renin, which helps regulate blood pressure; and the active form of vitamin D, which helps control the calcium balance in the body and maintain healthy bones. In undamaged kidneys, all the above functions are carried out efficiently. When does kidney failure set in? Kidney failure or renal failure will happen when the kidneys slow down or stop properly filtering waste from the body . “At that stage there is a possibility that the glucose concentration in blood and urine is higher than normal. The level of proteins in the urine also becomes significant and can be evident on taking tests,” says Innocent Mbarushimana, a laboratory technologist at Lancet Laboratories. Several studies show that, 90 per cent of kidney cases in adults are related to glomerular-based renal disease caused by diabetes, as well as hypertension and glomerulonephritis, which cause physicians to suspect kidney disease. In children, however, 70 per cent of chronic kidney disease is associated with tubulointerstitial disease and symptoms such as red blood cells in the urine, hypertension or edema. Dr Valerie Johnson, the chief of the division of pediatric nephrology and associate professor of clinical pediatrics at Weill Medical College of Cornell University, explains in an online article that unlike adults, children are more vulnerable to the side effects of kidney diseases. “Adults complete their physiological and intellectual maturation while infants and children are at the early stages of their developmental processes. This makes them vulnerable to the down side effects of chronic disease. The metabolic changes associated with kidney failure are known to be associated with abnormal growth as well,” he says. A blood sample being taken during kidney screening. (Solomon Asaba) The cause of delayed growth in children with kidney disease has been attributed to protein-calorie malnutrition, kidney losses of essential salts, increased tissue breakdown, metabolic acidosis, anemia, kidney-related bone disease and disturbances in the growth hormone-insulin-like growth factor. How to tell a sick child Obvious risk factors and manifestations in children include but are not limited to the following; swelling (even mild) of the hands and feet or puffiness around the eyes caused by excess fluid build-up, to the point where the child’s ability to move around normally is compromised, according to the World Health Organisation. According to the Journal of the International Pediatric Nephrology Association, after initial swelling, socks or a belt can leave an indentation in the skin that will persist. In children with kidney diseases, there is lack of or decrease in appetite, decreased or increased frequency of urination, bed wetting, change in the colour of the urine (unusually dark or brown) headache and flu. Unfortunately, treatment of kidney diseases is one of the most complicated procedures because once individuals are identified with such complications they either have to seek a transplant or rely on dialysis. Dialysis is very costly and the transplant is even more complicated. Like Dr Ntarindwa says, an individual with a kidney disease requires atleast 12 hours of dialysis per week. “This treatment is divided into at least four sessions, each lasting three hours per week. Each session costs about Rwf82,500 but could even be higher in other hospitals and that could bring the monthly total to over Rwf1m,” he says. Studies show that with early treatment, kidney diseases can be cured. But several findings also suggest that the presence of secondary infections such as HIV worsens the management of kidney diseases. editorial@newtimes.co.rw ***************************************** Taking care of the kidney - Avoid contact with all the toxic and harmful items.- Eat lots of fresh fruit and vegetables (particularly the latter) together with grass fed beef and free range chicken and eggs.- Stay away from sugars, sodas and artificial sweeteners, processed salty foods and the bad trans fats. Instead, change to natural salt and good fats such as butter from raw cream, olive oil and organic coconut oil. Stevia is a safe replacement for sugar.- Try to drink only water instead of other drinks. This should be pure filtered water – several glasses per day.- Maintain a healthy weight and, of course, this will be more easily achieved through the other lifestyle changes that you make.- Stay fit by at least 30 minutes of physical activity that increases your heart rate on five or more days of the week – suggestions include: walking, lawn mowing, cycling, swimming or gentle aerobics.- Don’t smoke and limit your alcohol to a maximum of two small drinks per day if you are male or one small drink per day if you are female.- Have your blood pressure checked regularly. If you blood pressure levels are higher than they should be, lower them with natural remedies rather than statins which can actually lead to kidney damage.- Do things that help you relax and reduce your stress levels.- Spirulina (from a safe source) helps to protect your kidneys. As kidneys are one of the first organs to suffer damage after significant radiation exposure, Spirulina is used – but research also suggests that spirulina helps protect from the nephrotoxicity of cancer treatments, antibiotics and analgesics.- Please be aware that many people today are gluten intolerant and as such can suffer from gluten induced kidney damage. If you are not sure or are suspicious that you might be gluten intolerant, get genetically tested for gluten sensitivity. If you have actually have kidney disease, make sure your doctor checks your 25 OH D levels (vitamin D). Additionally, make sure that he measures for other nutritional deficiencies as well. Malabsorption is a common cause of secondary diseases for those with intolerance or sensitivity to gluten.- It cannot be overemphasized how important vitamin D is to your general health including the kidneys. Vitamin D is not a vitamin at all but a steroid hormone that is probably the single most important factor in human health. The optimum level for good health is to be between 40 ng/ml and 100 ng/ml and if you are not receiving sufficient sunlight exposure, the average adult needs to take a daily dose of 8000 IUs daily to elevate their levels above 40 ng/ml. Agencies ***************************************** Care for children with kidney diseases Prince Rwagasore, a pediatrician Prince Rwagasore When a child is suffering from kidney disease, it’s always good to find out the cause and then treat it rather than treating the symptoms. But most importantly, a diet free of toxins should be the first medicine for a child with kidney problems. Bosco Hangenimana, a nurse Bosco Hangenimana Generally, one of the main causes of kidney failure in children is skin infection. The first thing that should be done is to give them antibiotics to cure the infection. On the other hand, if the child gets well and is discharged, the parents should make sure such it gets the required vaccination in order to prevent other infections. Herondine Uwajeneza, a nurse Herondine Uwajeneza Children with kidney problems normally have specific diets. They should be given foods that can be easily filtered by the kidney. The socio-economic welfare of the child should be good because if the environment is not condusive, the child can be affected psychologically, which can aggravate the condition. Dr Francis Kazungu, a general practitioner at Clinic de Medicare Dr Francis Kazungu It’s always good to educate the parents with children who have kidney problems how to provide the right care and medicine, but this depends on how severe the condition is. If the condition in the late stages, dialysis is always recommended. Compiled by Lydia Atieno