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Kidney Diseases in Children
About kidney failure
The term kidney function is used to describe how well the kidneys are working – especially how they filter blood and make urine.  In kidney failure, the level of kidney function is too low to support the body of your child. This may happen suddenly or over a long time.Â
Acute kidney injury (AKI): In AKI, the kidney function gets worse over a short period of time. Some children with severe AKI need dialysis for a few weeks or longer until their kidneys start working again.
Chronic kidney disease (CKD): In some children with CKD, the kidney function gets worse over a long period of time. CKD has five stages, and kidney failure happens in stage 5. It is also called end stage renal failure (ESRF) or established renal failure. Most children with stage 5 CKD need dialysis and/or a kidney transplant immediately.
Dialysis for your child
Dialysis is a life saving treatment for children in kidney failure.
What is Dialysis?
Your child may need dialysis if he or she is in kidney failure – this may happen suddenly or over time. Dialysis is one type of Kidney replacement therapy. This means it partly does the work of your kidneys. It is an important treatment for children for kidney failure.Â
What to consider before going for dialysis?
Dialysis types vary significantly, and there are many things to consider when you and your child decide which type is best for you. This includes:
- where the dialysis is performed – in the hospital or at home
- whether you and/or other family members or carers can undergo dialysis
- whether your house or apartment is suitable for dialysis at home and if any changes are needed
- how often your child needs dialysis how long each dialysis session lasts
- your child’s age
- how close you are to your dialysis unit
- risks and side effects in taking the treatment
What are the types of Dialysis?
There are two main types of dialysis – haemodialysis and peritoneal dialysis. Both of these require surgery before the dialysis can start. In many cases, families can decide the best type of dialysis for their child, in discussion with their healthcare team.
- type-I
- type-II
1. Hemodialysis
In hemodialysis, a machine with an ‘artificial kidney’ filters the blood. Blood is pumped out of the body through tubes and into the artificial kidney, and the cleaned blood is returned to the body
Preparing for Hemodialysis
Before dialysis can start, your child will need a procedure to get access to his or her body. This depends on the type of dialysis and how quickly it is needed.
A central venous line (or line) is a long, thin tube (catheter) that is placed into one of the large blood vessels in the body. This is usually in the neck or chest, or occasionally the groin (an area of hip between your stomach and thigh).
A line can be inserted shortly before the first dialysis session starts.
There are two types of lines.
- Temporary line – A temporary line can be placed for short-term dialysis.
- Permanent line – A permanent line can also be placed for long-term dialysis.
The catheter is inserted in the vein and then tunneled under the skin to exit at a different site. For example, if the catheter is inserted in the neck, it will exit on the front of the chest. This means that the exit site cannot be seen when your child wears a shirt.
Fistula: –
For most children who will be on dialysis long term, a fistula is the best option for hemodialysis – it usually lasts longer and has lower risks of infection.
What is a fistula?
An arteriovenous fistula, or fistula, is a connection between two types of blood vessels, a vein and an artery. This creates a larger, stronger blood vessel. For each dialysis session, one or two needles are inserted into the fistula – because it is a larger, strong blood vessel, it is easier to access. This is done several weeks before dialysis starts.
When should I get a fistula?
The fistula is usually made in an arm (the arm that your child does not draw or write with). It needs to be made at least 8–12 weeks before the first dialysis session, to allow time for it to develop and get strong enough.
How often is hemodialysis needed for children and how long does it take?
Each dialysis session usually is done 3-4 times a week is normally done during the day. It takes 3-4 hours in one dialysis session
How can you keep your children busy during dialysis session?
During the treatment, Children are connected to the machine, they have 3-4 hours to complete the treatment. You can use any of these ways to keep your children’s mind engaged.
- Every kid loves to watch Cartoon or a movie, you can play there favourite in a tab/laptop.
- You can also give them any story or school book to read.
- To make them happy , you can also take out some time and play games with them.
- They can also complete their school homework in this time.
- One of the best ways is let them take naps comfortably.
Happiness and comfort of your kid is very important. These simple ways can be helpful for the long dialysis sessions.
Are there any risks to hemodialysis?
It takes time to get used to the process of dialysis treatment, Haemodialysis does have some risks, including:
- Problems with the catheter or fistula – Germs can get into the catheter, fistula, or graft and cause an infection. Blood clots can block the catheter or fistula. The treatment team will teach you how to recognize these problems so they can be handled right away.
- Low blood pressure – It happens rarely that a children’s blood pressure can go down during treatment. If this happens, they might be dizzy, have a headache, or feel sick. The dialysis team can change the treatment plan to avoid this.
- Itching. Hemodialysis can make the skin feel itchy, especially during or right after a treatment.
Sleep problems. Some people can have trouble sleeping due to aching or restless legs or brief pauses in breathing.
How Can Parents Help?
When kids need dialysis, staying healthy helps them avoid such problems and feel their best. Parents can follow these few tips to avoid such risks: –
- Make sure your child eats the right healthy food. Don’t let them eat any processed or packed food items.
- Always plan in advance before travelling, keep the details of dialysis center nearby the travel destination.
Give medicines on time to your child. Kids often need medicines to control their blood pressure, help produce red blood cells, and control nutrient levels in the blood.
2. Peritoneal Dialysis
- Peritoneal Dialysis –
Peritoneal dialysis is a safe, simple and most common treatment option for children less than 5 years of age with chronic kidney disease stage 5. Provides continuous therapy, which acts more like natural kidneys.
Preparing for the Peritoneal dialysis
What happens in Peritoneal dialysis of children?
During peritoneal dialysis, the peritoneum, which is the lining of the abdomen (tummy), filters the blood by taking extra waste and water outside the blood.
A cleansing solution called dialysate goes into the belly. Waste and extra water seep across the lining of the belly into the dialysate, which then washes back out, bringing the waste and extra water with it.
This happens because of a process called diffusion. At the end of the dialysis session, the fluid with the waste products, extra water and salt is drained out of the abdomen into another bag, and then thrown away. This is the drain phase.
Where does peritoneal dialysis take place?
Most of the time, peritoneal dialysis is done at home. It can also be done in other places, such as school, other family members’ homes, or while on holiday.
What is a Catheter?
Peritoneal catheter, soft plastic tube, inserted through abdomen (stomach). A small incision is made in the abdomen to make a small hole. The catheter is inserted through the hole into the abdominal cavity . Children are usually in the hospital overnight or longer to allow time for recovery.
The point where the catheter exits the skin is called the exit point. It must be kept clean to avoid infection.
Why peritoneal dialysis is more suitable for children’s?
Peritoneal dialysis is a desirable therapy for your children, you can easily manage your child’s dialysis treatment with your daily everyday activities.
- Your child can go to school regularly and do extracurricular activities.
- No need to go to dialysis centre as the treatment can be easily done at home.
- There are less fluid and diet restrictions.
- You can perform this treatment while your child is sleeping.
- It is a less painful needle free treatment and easy to perform.
- You can prepare and travel with your child safely.
You can learn how to perform the procedure and let your child enjoy his childhood time happily.
Is Peritoneal Dialysis Uncomfortable?
Yes, there is some discomfort for a few days after the procedure to place the catheter. Your child should not feel any pain or discomfort after the surgery. Sometimes The catheter tip inside your abdomen may occasionally press against the abdominal wall. This may cause discomfort during times when the fluid is going in or draining out.
What are the risks in peritoneal dialysis?
- Infections
Infections from bacteria entering your body – especially peritonitis, which is inflammation of the peritoneum. Keeping exit clean reduces risk. Most infections can be treated with antibiotics that kill bacteria. If the infection is more severe, the catheter should be removed and a new catheter inserted after the infection has cleared.
- Hernias – Hernia occur when the inside of the body protrudes through the surrounding wall and a lump forms in the abdomen or
What dialysis cannot do?
 Dialysis does not do everything that kidneys do – such as help keep bones healthy and make red blood cells. Your child will have to take medicines to help with this.
What are the risks in Dialysis?
What are the risks in Dialysis?
 Dialysis is an important, life-saving therapy for children with kidney failure. Most children with kidney failure receive this treatment. However, it has side effects, affects the lifestyle of your child and your family and carries risks.
- A catheter – a long, thin tube inserted for some types of dialysis – can become infected. Your child’s health care team will show you how to care for the catheter and the skin around it (the outlet) to reduce this risk, and will check for signs of infection so it can be treated quickly.
- Some children feel more tired than usual during dialysis. Depending on the type of dialysis, there may be other side effects and risks.
- Dialysis is a complex treatment and has a great impact on the life of your child and your family. If your child has dialysis at home, you will be taught how to use the machine. If your child receives dialysis at hospital, he must travel to dialysis unit at least three times a week.
Dialysis and living with kidney failure can also have a huge emotional impact on the child and their family.
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How can you Support your Child?
How can you Support your Child?
Dialysis can be a difficult and stressful experience for your child and the whole family. It is a complex and time-consuming treatment which will impact your family life.
Your child’s healthcare team will give you more information and support you and your child throughout the treatment. You and your child will learn more over time about how to help live with dialysis. Your child’s healthcare team is there to guide you. They can provide support with your child’s education planning, accessing financial benefits through government schemes and planning holidays around dialysis. Speaking with other families of children on dialysis can also be a huge support.
For children with kidney failure (chronic kidney disease stage 5)
Kidney transplant
 For children with kidney failure (chronic kidney disease stage 5), the best treatment for kidney failure is a kidney transplant. However, for a kidney transplant, it is necessary to have a suitable – dead or living – kidney donor and that the child is ready for a kidney transplant. After a successful kidney transplant and taking medications that protect their new kidney, children can live full and healthy lives. The timing of a kidney transplant depends on many factors, including the availability of suitable donors. About , children need dialysis while waiting for these , procedures.
Babies and younger children under 2 years may have to wait until they are old enough for a kidney transplant.
What happens after a kidney transplant?
 After kidney transplant surgery, your child will spend a week or two in the hospital recovering. The healthcare team will carefully monitor the surgery to make sure there are no complications, such as bleeding or infection.
 You and your child will learn about the medications needed to prevent the body from rejecting the new kidney. These are called immunosuppressants.
Taking them can make your child more likely to get infections, especially in the days after surgery. So keep your children away from sick people.
 Everyone at home should wash their hands well and often. During the first months after surgery, you visit the doctor often to make sure that the new kidney is working well.
 If your child has a fever, diarrhea, less energy, or changes in the amount of urine, contact the transplant office right away. These may be signs that your child’s body is not accepting the new kidney or that the child has an infection.
How can parents care after kidney transplant?
Chronic illness can be difficult for your child. Dialysis, surgery and immunosuppressive therapy can increase stress. Talk to your child about these changes and how to incorporate them into your routine.
Make sure you have time to do fun things with family and friends.
For teenagers, immunosuppressive therapy can be a challenge.
These medications can cause: acne or acne that gets worse weight gain mood changes sleeping problems hair loss many of these side effects get better with time.
 But they are a big reason why teenagers can stop taking medications after a transplant. This can be dangerous and even lead to rejection of the new kidney. Do not change or stop medications without talking to your care team. In some cases, medications can be changed to reduce side effects and still be effective and safe. Talk to your child about the importance of taking all medications as directed and help them do so.
How can you help your children after transplant?
The best thing you can do is keep them engaged and  simply talk to them about their problems.
 If your child needs more support, make an appointment with a therapist or counsellor.
Find a support group. They are a great way for children and youth to relieve stress and connect with others with similar challenges. Online resources include Transplant Living. Get support for yourself too. It can help to talk about your feelings with other people who know what you are going through. Ask your transplant care team if they know of any support groups for families.
