Combating chronic kidney disease in children
Just like adults, Chronic Kidney Disease (CKD) can affect children and may be catastrophic and life threatening incident that leads to high morbidity and mortality. Paediatric renal disease accounts for approximately 5-7 percent of hospital admissions in a pediatric unit of tertiary hospitals in Bangladesh. Statistics says that about 2 crore population have been suffering from kidney related problems and a significant number of the patients are children. About one-third cases of renal insufficiency occur due to genetic or hereditary causes. These are largely preventable if detected early. Chronic Kidney Disease (CKD) is used to describe patients with kidney damage or decreased level of renal function for three months or more, irrespective of the underlying condition and is defined as the presence of kidney damage. The most common causes of CKD in children are obstructive uropathy and glomerulopathies. These two abnormalities account for more than 50 percent of the reported cases of end-stage renal disease in children. The other major causes are hereditary nephro-pathies and renal hypoplasia and dysplasia. CKD may also develop from acute renal failure due to diarrhoea or dysentery, post febrile, insect bite. Children with chronic kidney failure may not have any symptoms until about 80 percent of their kidney-function is lost. Then they may feel tired, fail to thrive, may have nausea or vomiting, have difficulty concentrating or experience confusion. Accumulated fluid appears as swelling in the face, skin, abdomen, leg and fluid congestion in the lungs and high blood pressure. At this stage (called End-Stage Renal Disease or ESRD), all children must receive dialysis or transplant to sustain life. The two forms of dialysis are hemodialysis and peritoneal dialysis. Peritonial dialysis is still the favored mode of dialysis in younger children than haemodialysis. Peritoneal dialysis uses the body's own peritoneal membrane — beneath the outer layers of the abdominal wall — to filter the blood. It requires fewer dietary and fluid restrictions and offers more lifestyle flexibility. Needs of kids with chronic kidney disease often include dietary changes. Ensuring that they get adequate calories and proper amounts of various nutrients can be a challenge. Supplementing your child's diet with extra carbohydrate and fat might help to increase calorie intake. The kidneys cannot easily remove excess water, salt or potassium, so their intake need to be limited. Dairy products have to be restricted because they contain large amounts of phosphorus. Too much phosphorus may lead to calcium deposits in the eyes, heart, skin and joints and may leach calcium from bones, which can increase the risk of broken bones. But eliminating dairy foods can make it difficult for kids to get enough calcium to maintain bones and support other body functions, particularly those affecting growth. In kids with more severe kidney failure, reducing the intake of dairy products and other protein-rich foods (such as meat, fish or eggs) can make the filtering work of the kidneys easier and can sometimes delay the need for dialysis. Some kids with kidney disease, particularly those with high blood pressure, may need to restrict their intake of sodium, which is found in table salt and many foods. Read food labels and talk to your doctor or a dietitian might about the sodium content of various foods. Consult your Nephrologist about an appropriate diet that meets your child's need for calories and nutrients while minimising damage to kidneys and avoiding other complications. Exercise will help your child perspire to get rid of excess fluid and flush out toxins through the skin. Beyond physical concerns, kids should be encouraged to express their feelings. Try to find well-adjusted young adults who had chronic kidney disease during childhood to talk with you and your child. It is important for kids to see that the symptoms of the disease can be managed and controlled and that they can live a full life. The outcome of children with severe CKD is highly dependent on the economy and availability of health care resources. Approximately 90 percent of treated ESRD patients come from such families those can not afford the cost of Renal Replacement Therapy (RRT). At government hospitals, kidney transplantation costs about taka 2 lacs. Post transplant medicare costs 10-15 thousand taka per months up to 6 months and around 10 thousand taka for the rest of life. For dialysis 2 lacs taka is needed per patient per year. The most favored renal replacement modality in children is renal transplantation in all paediatric age groups. All types of renal replacement therapy for children are available in Bangabandhu Sheikh Mujib Medical University (BSMMU), National Institute of Kidney Disease & Urology (NIKDU) and Dhaka Shishu Hospital. Dialysis and transplantation ensures 80 to 90 percent of rehabilitation, but it is expensive and it is not available everywhere. So, prevention and early detection is essential to prevent kidney disease in children of Bangladesh. Following measures can be taken for prevention of kidney disease in children: -Epidemiological survey of kidney diseases -Early detection and referral to tertiary hospital -Antenatal screening for renal anomalies -Appropriate fluid balance during diarrhoea/dysentery -Prohibition of drug sale without prescription of registered physician -Awareness by health education and mass propaganda
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