Can renal failure be seen in children?
Chronic renal failure is a serious condition that can be encountered in all age groups, including children. Studies demonstrate that 3 of every one million child have chronic renal failure.
What are causes of chronic renal failure in children?
Congenital anomalies are the most common reasons of chronic renal failure in children. The most frequent one is “vesicoureteral reflux”. In vesicoureteral reflux, urine flows from the bladder back up to the kidneys. This condition is accompanied by recurrent urinary tract infections and causes wounds in the kidneys and dysfunctions in the long term. Other congenital anomalies are the underdevelopment of kidneys or urinary bladder in the womb and occlusions in urinary tracts or canals inside the kidneys. Moreover, some inherited conditions are also an important cause of the failure. Examples of such conditions are polycystic kidney disease or Alport syndrome. Nephritis is also an important etiology for the renal failure. The renal disease, called “nephritis”, has various types and some of these can lead to renal failure. In addition, certain conditions that affect the total body, such as lupus or diabetes, can also cause renal failure. These conditions are not directly associated with the kidneys, but these can cause damages in various body parts and the kidneys.
What are symptoms of chronic renal failure in children?
Chronic renal failure is a very insidious condition and it may stay asymptomatic especially at early ages. In rapidly progressing renal failure in children, volume of urine reduces and it is manifested by pallor, fatigue, loss of appetite, vomiting, swelling in face and legs, and shortness of breath.
Urine volume is high in the first couple of years of long-term and insidiously progressing renal failures; children might get up to urinate several times at every night. First, fatigue develops and the condition is mostly skipped at this stage. Hypertension and swelling in eyelids and legs are seen in more advanced stages. Grow rate reduces and lack of appetite and paleness develop over the time. Bone development impairs, pain and curvatures can be seen in bones, especially legs, and the urine output may decrease. If the condition progresses severely, patients can suffer from seizures or comas, develop pulmonary or cardiac problems or suddenly lose their life.
Does chronic renal failure affect development of the child?
Chronic renal failure is among most important causes of growth retardation in children.
Since growth and development continue in children, renal failure leads to very serious damages. Growth, development and sexual development stages retard and their learning capacities decrease. Children cannot gain weight and eat healthy. Moreover, the dietary restrictions imposed on these children are serious challenges for both the children and the parents. Kidney failure is also associated with introversion and depression.
Therefore, your child should be brought to a pediatrician, if your child suffers from fatigue, gets tired quickly, is not as active as in the past and you recognize growth retardation.
Which conditions make transplantation necessary for my child?
Kidney transplantation is the best treatment method for all babies and children with end-stage kidney failure. Comparing to dialysis therapy, the kidney transplant prolongs lifetime, ensures a normal growth and provides a perfect quality of life for children at all ages.
Children with kidney failure cannot complete their body development comparing to their peers due to growth retardation and their lives are negatively affected by underweight and short stature. Hence, the kidney transplant is a must for children with chronic renal failure, especially ones younger than 5 years of age. While underweight and short stature was hindering kidney transplant in the past, it can, now, be performed for children with body weight of 6-7 kg thanks to developing technology, production of alternative medications and surgical experiences. Kidney transplant for children with short stature and underweight requires care and skill. When the kidney that used to function in adults is transplanted to children, it causes 10-20 times more urine output in early postoperative period. The large kidney covers half of child’s abdomen. Adaptation of the child to the new kidney may take one week to 10 days. Adaptation to the large kidney takes time and carries risk for the little body of child. However, children start growing fast and run and play like their peers, after they get over this problem with close follow-up and careful medical care.
The first year after the transplant is very important for children who have experienced developmental problems due to their medical condition. Growth and development are comparable to their peers, after children spending a healthy year after the transplant. They can continue their education and sports.
How are evaluations done?
While the only hope for pediatric patients was the deceased donor kidney transplant in the past, specialists reports that success rates are ever increasingly rising especially in living donor transplants thanks to developing surgical techniques. Kidney transplant that could not be performed in too young children is now carried out successfully. Children with body weight of 6 kg and even 6-month old babies can be transplanted large kidneys donated by their relatives and other adults in our centers.
Does my child necessarily need a kidney from a child?
No, kidneys of adults can also be transferred to your child. Comparing to the children donors, more successful outcomes are obtained especially when adults’ kidneys are transplanted to babies.
Is domestic education necessary for one year after the transplant?
This is at your decision. Some people organize domestic or home education for their children after the transplant, but it is not necessary. Children can usually resume a normal life 1 to 3 months after the transplant.
How should children’s diet be after the transplant?
Your children should not consume below written foods and drinks after the transplant.
- Fizzy drinks
- Hamburger
- French fries
- Junk foods
- Nuts
- Ice cream
- Sugar
- Chocolate
- Chewing gum
Does deceased donor kidney transplant for children differ from adults?
How does the deceased donor transplant process work in children? The TDIS (Transplantation, Dialysis and Monitoring Systems) ensures a quick, transparent and fair process to transfer the deceased donor organs to appropriate patients. The most important characteristic of this system is the ability to follow the principle of transferring organs of pediatric donors (younger than 18) to the most appropriate one amongst pediatric patients.
For the organ donations by patients with declared brain death, if the donor is in pediatric age range, the deceased donor kidneys are again assigned by Ministry of Health to the children registered in the Organ Waiting List.
How is care of my child maintained in waiting period?
If your child is suffering from Chronic Renal Failure and is registered in waiting list, dialysis therapy should be maintained until the transplant. Moreover, parents should be careful about the child’s nutrition. You will need to make your child eat necessary nutrients on one hand, while you should make some restrictions in diet to decrease the harmful agents in body on the other hand, as kidneys are not functioning sufficiently.
Your child should especially avoid from oral fluids and foods rich in salt, phosphorus and potassium. You should necessarily follow the recommendations of pediatric nephrologist, who follows up your child, and ask every question you have.
How will daily life of my child be affected after transplant surgery?
There is no doubt that your child will have a healthy future surely with your attentive and watchful care... Children can return to normal life in a short time, when they are properly protected against infections and take prescribed medications regularly after the transplant. Although school life is paused in many children, they can continue attending school after the transplant. Families have important duties in this issue.
- Your child does not need to wear mask after the transplant.
- Your child can go outside and/or your child’s friends can visit him/her at home.
- You do not need to isolate the child in a separate room.
- Your child can go to school and attend to all classes including physical education.
- Young children can play in playground.
- You can go to shopping malls with your child.
- You can use taxi, bus and other public transportation means with your child.
- Your child can swim in sea.
Considerations after the transplant:
- If your child’s body temperature measures >38 ℃, do not try to treat your child on your own and do not use antibiotics based on your discretion. If you face such a condition, definitely contact your doctor or visit a hospital.
- The prescribed immunosuppressive medications that your child takes until his/her body accepts the transplant kidney may weaken the immune system.Therefore, an infection in your child’s body may exacerbate and become a serious condition more quickly comparing to other children.Therefore, diagnosis should be established and treatment should be instituted as soon as possible.