In the developed world up to 5% of patients with chronic kidney disease are children. But statistics are harder to come by in the developing world.
The overall increase in the incidence of kidney failure in children mimics that of adults. This is largely due to an increase in the incidence of obesity in children. Obese children develop hypertension and diabetes at a much younger age, which in turn affects their kidneys.
Kidneys perform vital functions. They rid the body of waste products and excess salts that would otherwise make people ill. They also:
- help the body maintain a good chemical balance;
- control blood pressure;
- keep bones healthy; and
- help make red blood cells.
Preventing kidney disease in children requires vigilance and awareness on the part of parents. Parents can do several things to help their children stay healthy and prevent chronic kidney disease. Four are listed below.
1. A healthy diet
Parents should keep their children fit, active and eating well to ensure that they do not become overweight. As a start, children should be encouraged to take part in school sports, and families should become more active.
But parents should also ensure that their children eat healthy, well-balanced meals. Eating well helps children maintain a balanced weight. This will decrease their risk of obesity, which in turn decreases the risk of kidney failure. A healthy diet also helps to regulate blood pressure.
A balanced diet contains a mix of protein, fat and carbohydrates. It includes fresh fruit and vegetables instead of canned or refined foods. The refined carbohydrates found in processed foods, fizzy drinks, crisps and sweets result in children having both a sugar and salt overload. These should be kept to a minimum.
Salt is often “hidden” in foods and is not only found in crisps or other obvious snacks. Lower salt intake will decrease children’s risk of developing hypertension earlier in life and, in turn, kidney disease. If children complain of chronic headaches and fatigue, their blood pressure should be checked as they may be at risk of hypertension. Every time parents take their children to the doctor or nurse, they should ask for the child’s blood pressure to be checked. This can also be checked when immunisations are done.
In addition to checking the blood pressure, parents should also have their children’s blood glucose levels checked on at least an annual basis. Diabetes, like hypertension, is a silent disease. Only when a child’s blood sugar is extremely high, will he or she become symptomatic. An early sign of suspected diabetes in children is excessive thirst – not just drinking a lot of water when it is hot, but drinking large quantities of water with an extreme thirst.
2. Sufficient fluid intake
Children need to drink enough healthy fluids, especially water. This allows the kidneys to stay healthy. Sugary drinks, including fruit juice, should be kept to a minimum.
Children’s kidneys can be affected after an infection or as part of a systemic illness, even as a result of something as simple as a throat infection (pharyngitis). When this happens there may be a change in their urine. They may pass less urine or their urine may change colour – the most common signs of trouble are urine that turns rose or red in colour, or the colour of black tea.
If a child is dehydrated and drinks large quantities of water, he or she should not pass a lot of urine. This is because the body has absorbed the water. Children who drink excessive amounts of water and pass urine frequently may be showing signs of diabetes.
Parents should ask for a urine dipstix test to be done when they take their child for a checkup. This is important because persistent protein in the urine is one of the earliest indications that a child’s kidneys might be taking strain. If a child is healthy, an annual checkup should be sufficient.
3. No smoking
Smoking is another big no-no. Children should be dissuaded from smoking, especially during their teenage years, when they are more likely to experiment with cigarettes. Cigarettes contain toxins that can damage blood vessels and cause heart diseases that in turn damage kidneys.
4. Beware of over-the-counter drugs
Parents tend to buy over-the-counter medicines for their children, but many drugs, especially anti-inflammatory medication and drugs used for fevers, can be harmful to their kidneys.
Aspirin, which is common in colds and flu medication, is not recommended for children under 12 due to the effect it has on their livers. Similarly, some anti-inflammatory drugs should be dispensed by a medical professional as they can cause acute kidney failure when children are dehydrated, ill and not taking in sufficient fluids. Paracetamol is a safe drug to use for fever in children, but it’s important that parents read the package insert to determine the dose and frequency for their children.
Christel du Buisson is a Paediatric Nephrologist and Senior Specialist in the Department of Paediatrics and Child Health at the Faculty of Medicine and Health Sciences at Stellenbosch University.