Kidney failure

By kidney failure, we mean that the kidney is not able to get the waste, salt and water out of the body resulting in collection of these waste products inside. These can be measured by simple blood tests (serum creatinine, blood urea). There are two types of kidney failure- acute or reversible (that is expected to improve over days to weeks) and chronic or irreversible (that does not get better with treatment and is progressive, ultimately requiring dialysis and kidney transplantation).

Acute or reversible kidney failure is usually due to disturbance in body’s immune (fighting) system, infections (bacterial, viral, fungal), stones, high blood pressure, heart disease and sometimes medications (such as pain killers). In contrast, irreversible kidney failure in children is usually due to genetic or structural problems noted in 40 per cent and acquired in remaining 60 per cent.

Children presents with decreased urine output, body swelling, breathing difficulty to collection of water in lungs, vomiting, headaches, seizures or fits and sometimes, increased sleepiness. Some children may have skin rash, joint pains, fever, or diarrhea as well. Children with chronic kidney failure present with inadequate growth, increased urination, and increased water intake.

Kidney failure can be confirmed based on simple blood and urine tests. Some children with kidney failure may need kidney biopsy to define the pathology for accurate therapy. Biopsy is usually a safe procedure where one or two small pieces of kidney tissue obtained through a needle are sent for pathological examination.

Treatment
There are two aspects of therapy – one is supportive care that includes control of high blood pressure, correction of salt disturbances, treatment of infection, nutrition and second is specific therapy where use of immunosuppressive medications may be necessary.

Some children with kidney failure may require dialysis to remove the accumulated waste and salt in the body using a blood filter or stomach cavity. Dialysis is stopped once the kidney function improves. Most children with acute kidney failure recover their kidney function over days to weeks depending upon the cause and usually do not have a recurrence. However, these children need long term follow up for growth, blood pressure, urine examination, and serum creatinine once a year for at least the next 20 years.

Children whose kidneys have been damaged irreversibly have a progressive course and need either dialysis or kidney transplantation when the kidney function falls below 15 per cent of normal. Kidney transplantation is the modality of choice to improve quality and prolong life.

In kidney transplantation, the donor can be a healthy, close family members (usually the parent or adult sibling) or deceased donor (brain dead person). The living donor will have a normal quality and quantity of life after the donation. Post-transplantation, the child (recipient) has to take certain medications called immunosuppressive medicines for life long.