Acute kidney injuries: Early treatment is vital

Cases of children under the age of 16 developing acute kidney injury, also known as acute renal failure, have been on the rise according to medics. Dr Gilbert Rugamba, a pediatric nephrologist at King Faisal Hospital, Kigali, and president of the Rwanda Renal Society, says a recent study carried out over two months at King Faisal Hospital indicated that 7-10 of children from infant to 16 years of age had acute kidney injuries. Dr Gilbert Rugamba, during the interview. / Lydia Atieno. Similarly, a recent study carried out at University Teaching Hospital of Kigali (CHUK) showed that there were 100 cases of patients with the same condition, while 30 of them needed to undergo complex procedures such as dialysis. “This is so alarming,” says Rugamba. “Acute kidney injury is very common in children. We should see chronic kidney diseases more often but, in general, the public and even some medics are not aware that this is generated from acute kidney injuries and instead come to seek consultation in the late stages when chances of mortality are very high,” he explains. Rugamba adds that, if well-managed, most chronic kidney diseases can be prevented from reaching the level of kidney transplant. One of the challenges that could also have brought about this, he says, is the limited number of experts specialised in pediatric nephrology for treating children. “This could be the root to the common causes of chronic kidney diseases that are emerging rapidly. When children have some infections, without proper treatment and follow up, the condition keeps on advancing to complex stages such as chronic kidney diseases as they grow,” he says. Rugamba says, for the first time they have come up with a full nephrology programme that offers proper dialysis, management, prevention as well as whole package of chronic kidney management for children from infancy to 16 years at King Faisal Hospital, Kigali. According to Rugamba, previously, children with such problems have been consulting only pediatricians and nephrologists who are not pediatrics. Rugamba adds that parents should feel safe as their children can now access such services from the right experts and prevent cases of kidney damage. Causes of chronic kidney diseases Rugamba says there are some stages one goes through before developing chronic kidney diseases, but emphasises that if well-treated and managed one can avoid complications of the kidney in general. “There is a need for general doctors and every health worker to understand that infections such as urinary tract infections (UTI) can be a sign of a broader structural abnormality of the kidney, especially in children. If not managed or followed up properly after treatment, this can lead to acute kidney injuries which further develop into chronic kidney diseases,” he says. “UTIs being the most common infection in children, around 8 per cent of children will have one episode by the age of 11,”he adds. Rugamba says malaria and severe dehydration are just some of the conditions that can cause kidney damage if not well-treated. He says all this can be prevented through proper investigations and tests to rule out any damages of the kidney, especially in cases of UTIs. How to diagnose the problem According to Dr Charles Sindabimenya, a neurologist at Doctors Plaza in Kimironko, Kigali, depending on the age, there are different conditions that could point to kidney problems. For instance, he says, in early age most of cases are congenital abnormities, and this can be ruled out during an antenna ultra sound which aids in establishing if the kidney is normal or not. “At birth and in infancy, they can manifest with urinary truck infections. Between 6-12 years, it’s more of inflammation of the kidney, nephrities or structural abnormalities causing loss of proteins, while from 12 to 16, the diseases manifest in the same way they do in adults,” he says. Sindabimenya also notes that, apart from UTIs, infections such as malaria, hepatitis and streptococcal, if not well-treated can lead to poor perfusion to the kidney, thus its damage. Manifestation Dr Yves Bandora, a member of Health Kidney Foundation Rwanda, says kidney diseases are dived into many conditions. For instance, he says, congenital abnormalities of the kidney are manifested in general by urinary tract infections with symptoms like fever and abdominal pain, among others. UTIs may also signal that the patient may be having other structural abnormalities that need to be treated to prevent further complications. “Another sign is Inflammation of the kidney or the loss of protein in the kidney. The only way to identify this is noting that a child has a swollen face,” he says. Bandora cautions that even if these conditions are treated and go away, a specialist should make sure that there are no damages to the kidney, and this can only be achieved through proper examination. Treatment “Prevention of progression of kidney diseases by properly managing UTI infections and severe dehydration that can cause kidney damage and taking care of all types of kidney diseases is vital,” says Didier Nkurikiyeyezu, the executive director of Healthy Kidney Foundation Rwanda. But in cases of some hereditary diseases, where the child is born with renal malfunction, Rugamba says renal replacement therapy is a better option. “This allows the child to grow with chronic kidney disease and get renal replacement therapy or treatment for other complications that could occur in their adulthood. Dialysis is given to those who need it, while kidney transplant is not when there is failure of kidney functioning completely,” he says. However, to achieve better treatment, Nkurikiyeyezu says it all lies in preventive, curative and management of symptoms as all these tend to slow down the progression of chronic kidney diseases. On the other hand, Rugamba says checking for nephron mass is another way that can help in preventing chronic kidney diseases. “Nephron is the structural functional unit of the kidney that helps in filtering blood, secretion of hormones that make blood cells as well as regulate water, calcium and prosperous levels in the body,” he says. Rugamba adds that, as one grows up, they lose nephron mass progressively. “Therefore, prevention and treatment of conditions that could result in chronic kidney diseases prevents one from progressively losing nephron mass, especially at a younger stage. Management Dr Sindabimenya says chronic kidney diseases are divided into 5 stages. “The management depends on the stages of chronic kidney diseases. For example, in the beginning of the acute kidney injuries, patients can eat or drink just like any other normal person, but emphasis should be put on getting treatment as early as possible,” he says. He points out that apart from early treatment, such patients should also be given medication that is kidney friendly (non-nephrotoxic). They should also be followed up frequently for check-up of fluid, blood pressure and electrolyte balance because of their reduced renal function. However, when they progress to the last stage, which is chronic kidney disease, Sindabimenya says such patients need to have a special diet without potassium and phosphate, as well as regulated fluid intake. He says all this should be done with the support of a nutritionist.