Kidney diseases in children

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Kidney diseases in children: complete guidance

I. Introduction to pediatric nephrology

Pediatric nephrology is a specialized field of medicine that is engaged in diagnosis, treatment and prevention of kidney diseases in children, from newborns to adolescents. The kidney function is crucial for maintaining overall health, regulating the water-electrolyte balance, removing metabolic products, producing hormones and controlling blood pressure. In children, the kidneys are especially vulnerable, since they are still in the process of development and maturation. Paths of kidneys in childhood can have long -term consequences that affect growth, development and quality of life. Early detection and timely intervention are important for optimizing results.

II. Anatomy and physiology of children’s kidneys

The kidneys are a paired organ of a bean -shaped shape located in the posterior abdominal wall. Each kidney consists of approximately a million functional units called nephrons. Nefron is responsible for the filtration of blood, reabsorption of the necessary substances and the release of waste in the form of urine. In children, the kidneys are anatomically and functionally different from adult kidneys.

  • Anatomical features: In children, kidneys are relatively larger than body weight. The structure of the kidneys, especially the nephrons, continues to develop in the first years of life. This development affects the ability of the kidneys to concentrate urine and cope with changes in the electrolyte balance. The ureters, the bladder and urethra also undergo development, which makes children more susceptible to certain diseases, such as a bubble-free reflux (PMR).

  • Physiological features: Glomerular filtration (SKF) is a measure of kidney performance. In newborns, SKF is lower than in adults, and gradually increases during the first few years of life, reaching adult levels by 1-2 years. The ability of the kidneys to reabs the glucose, amino acids and other important substances also develops over time. The endocrine functions of the kidneys, such as the production of erythropoietin (hormone, stimulating the production of red blood cells) and activation of vitamin D, are also important for the growth and development of children.

III. Classification of kidney diseases in children

Kidney diseases in children can be classified in various ways, depending on the cause, localization of damage or clinical manifestation. General categories include:

  1. Congenital kidney and urinary tract abnormalities (Cakut): This category includes structural defects in the kidneys and urinary tract that occur during the development of the fetus. Examples include kidney agenesis (the absence of one or both kidneys), kidney dysplasia (anormal development of the kidneys), ureter obstruction, urterocell (cystic expansion of the distal ureter) and a horseshoe -shaped kidney (the merger of two kidneys).

  2. Glomerular diseases: These diseases amaze glomeruls filtering units of the kidneys. Examples include:

    • Nephrotic syndrome: It is characterized by proteinuria (the presence of protein in the urine), hypoalbuminemia (low albumin in the blood), edema and hyperlipidemia (high level of lipid in the blood). The most common cause in children is a disease of minimal changes.
    • Glomerulonephritis: Inflammation of glomerul, which can be caused by an infection, autoimmune diseases or other causes. Examples include post-Straptococcal glomerulonephritis (PSGN) and IgA-nefropathy (Berge disease).
    • Membrane -propoliferative glomerulonephritis (MPGN): A rare type of glomerulonephritis, characterized by cell proliferation in glomerulas and the deposition of immune complexes.

  3. Tubul -interstitial diseases: These diseases affect the renal tubules and interstitial tissue. Examples include:

    • Pyelonephritis: The infection of the kidneys, usually caused by bacteria that fall into the kidneys from the lower urinary tract.
    • Interstitial jade: Inflammation of the interstitial tissue of the kidneys, which can be caused by drugs, infections or autoimmune diseases.
    • Renal tubular acidosis (PTA): A group of disorders characterized by the inability of the kidneys to acidify urine, which leads to metabolic acidosis.

  4. Urolithiasis (nephrolytiasis): The formation of stones in the kidneys or urinary tract.

  5. Acute renal failure (OPN): A sudden decrease in kidney function. The OPN can be caused by various factors, including dehydration, infections, medicines and uterine obstruction.

  6. Chronic kidney disease (HBP): A gradual and progressive decrease in kidney function over several months or years. CHBP can be caused by various factors, including congenital kidney anomalies, glomerular diseases and tubulo -stistical diseases.

  7. Hereditary kidney diseases: A group of diseases inherited and affecting the kidneys. Examples include:

    • Polycystic kidney (PKP): Genetic disease characterized by the formation of multiple cysts in the kidneys.
    • Alport syndrome: A genetic disease affecting glomeruls causing hematuria (blood in the urine), proteinuria and progressive renal failure.
    • Cystinosis: A genetic disease characterized by the accumulation of cystine in various organs, including the kidneys, which leads to damage to the kidneys.

IV. Etiology and pathogenesis of kidney disease in children

The causes of kidney diseases in children are diverse and depend on a specific disease.

  • Genetic factors: Many kidney diseases, especially Cakut and hereditary kidney diseases, have a genetic basis. Mutations in certain genes can lead to anormal development of the kidneys, impaired function of glomerul or tubules, or the accumulation of toxic substances in the kidneys.

  • Environmental factors: Some environmental factors, such as the effects of toxins, infections and drugs, can contribute to the development of kidney diseases in children. For example, some drugs can cause interstitial nephritis or UPN.

  • Immunological factors: Autoimmune diseases, such as systemic lupus erythematosus (SLE), can affect the kidneys, causing glomerulonephritis. Infections, such as streptococcal infection, can provoke an immune response, which leads to PSGN.

  • Infections: Urinary tract infections (IMP), especially if they are not treated, can lead to pyelonephritis and scarring of the kidneys.

  • Obstruction: The obstruction of the urinary tract caused by kidney stones, tumors or structural anomalies can lead to hydronephrosis (kidney expansion) and kidney damage.

V. Clinical manifestations of kidney diseases in children

Symptoms of kidney diseases in children can vary depending on the type and severity of the disease. General symptoms include:

  • Swelling: Facial edema, eyelids, legs or the whole body. The edema is caused by a delay in fluid associated with impaired renal function.
  • Changes in urination: Changes in the volume of urine, urination or appearance. Symptoms may include polyuria (increased urination), oliguria (reduced urination), hematuria (blood in urine) or proteinuria (foamy urine).
  • Abdominal pain or side: The pain can be caused by kidney infection, kidney stones or obstruction of the urinary tract.
  • High blood pressure (hypertension): The kidneys play an important role in the regulation of blood pressure. Kidney diseases can disrupt this regulation, leading to hypertension.
  • Fatigue and weakness: Anemia (low level of red blood cells), associated with CBP, can cause fatigue and weakness.
  • Growth delay: HBP can affect the growth and development of children.
  • Night urinary incontinence (enuresis): It may be associated with the problems of urine concentration or structural anomalies.
  • Vomiting and nausea: Can be symptoms of the OPN or HBP.
  • Urinary tract infections (IMP): Frequent or recurring IMPs can indicate the underlying kidney disease or structural anomaly.

VI. Diagnosis of kidney diseases in children

Diagnosis of kidney diseases in children includes a thorough history of the anamnesis, physical examination and a number of diagnostic tests.

  • Anamnesis: It is important to get a detailed history, including a family history of kidney diseases, the history of previous infections, drugs and symptoms.

  • Physical examination: A physical examination can identify signs of edema, high blood pressure or other signs of kidney disease.

  • Urine analysis: Urine analysis is an important diagnostic test that can identify the presence of blood, protein, glucose or bacteria in the urine. He can also measure the specific gravity of urine and pH.

  • Blood tests: Blood tests can measure the function of the kidneys (SKF, creatinine, urea), electrolytes, albumin and other parameters that may indicate a kidney disease.

  • Visualizing research:

    • Ultrasound kidney examination: A non -invasive visualizing study that can identify structural anomalies, hydronephrosis, kidney stones and other deviations.
    • Intravenous pyelography (GDP): X -ray examination, which includes the introduction of a contrast matter for visualization of kidneys and urinary tract. GDP can identify obstruction, structural anomalies and other deviations.
    • Radionuclide kidney scanning (DMSA scanning): A visualizing study that can evaluate the function of the kidneys and identify the scarring of the kidneys.
    • Cystowroxography (gathering): X -ray examination, which includes the filling of the bladder by contrast agent and the receipt of x -rays during urination. CUG can identify PMR and other abnormalities of the bladder and urethra.
    • Magnetic resonance tomography (MRI): A visualizing study that can provide detailed images of the kidneys and urinary tract. MRI can be used to diagnose Cakut, kidney tumors and other conditions.

  • Kidney biopsy: The kidney biopsy includes a small model of kidney tissue for a microscopic examination. A kidney biopsy may be necessary for the diagnosis of glomerular diseases, tubulo -stistucial diseases and other conditions.

VII. Treatment of kidney diseases in children

Treatment of kidney diseases in children depends on the type and severity of the disease. The purpose of treatment is to control the symptoms, a slowdown in the progression of the disease and the prevention of complications.

  • Drug therapy:

    • Antibiotics: Used to treat kidney infections (pyelonephritis).
    • Corticosteroids: Used to treat nephrotic syndrome and some types of glomerulonephritis.
    • Immunocationthretarite: They are used to treat autoimmune kidney diseases, such as squeezes.
    • ACF and sconces inhibitors: Used to control high blood pressure and reduce proteinuria.
    • Diuretics: Used to reduce edema.
    • Drugs connecting phosphates: Used to control the level of phosphates in patients with CBP.
    • Eritropoetin: Used to treat anemia in patients with CBP.
    • Vitamin D: It is used to treat vitamin D deficiency in patients with CBP.

  • Diet: Diet can play an important role in the treatment of kidney diseases in children. Dietary recommendations depend on a specific disease and may include:

    • Salt restriction: Helps control high blood pressure and reduces swelling.
    • Protein restriction: It may be necessary in patients with CBP to reduce the load on the kidneys.
    • Phosphate restriction: It is necessary in patients with CBP to prevent hyperphosphatemia.
    • Potassium restriction: It may be necessary in patients with CBP to prevent hypercalemia.
    • Adequate fluid intake: It is important to maintain hydration and prevent dehydration.

  • Surgical treatment: Surgical treatment may be necessary to correct structural anomalies, remove stones in the kidneys or treatment of uric obstruction.

  • Dialysis: Dialysis is a blood purification method that is used when the kidneys cannot perform their function. There are two main types of dialysis: hemodialysis and peritoneal dialysis.

  • Kidney transplantation: Kidney transplantation is a surgical procedure in which a sick kidney is replaced by a healthy kidney from the donor. Kidney transplantation is the best treatment option for patients with the terminal stage of CBP.

VIII. Prevention of kidney diseases in children

Although not all diseases of the kidneys can be prevented, there are several steps that can be taken to reduce the risk of developing kidney diseases in children.

  • Prenatal care: Adequate prenatal care, including ultrasound, can help identify Cakut before birth.

  • Vaccination: Vaccination can help prevent infections that can lead to kidney diseases, such as PSGN.

  • Hygiene observance: Compliance with hygiene rules, such as frequent hand washing, can help prevent the IMP.

  • Timely treatment of IMP: Timely treatment of IMP can help prevent pyelonephritis and scarring of kidneys.

  • Restriction of the use of drugs toxic for kidneys: Some drugs can be toxic for kidneys and should be used with caution, especially in children.

  • Control of blood pressure: Control of blood pressure is important to prevent kidney damage.

  • Healthy lifestyle: A healthy lifestyle, including a balanced diet, regular physical exercises and smoking, can help prevent kidney disease.

IX. Complications of kidney diseases in children

Kidney diseases in children can lead to a number of complications, including:

  • HBP: A progressive decrease in kidney function.
  • Opn: A sudden decrease in kidney function.
  • Hypertension: High blood pressure.
  • Anemia: Low level of red blood cells.
  • Growth delay: HBP can affect the growth and development of children.
  • Bone diseases: HBP can lead to bone diseases such as renal osteodistrophy.
  • Cardiovascular diseases: HBP increases the risk of cardiovascular diseases.
  • Infections: Patients with kidney diseases are more susceptible to infections.
  • Death: In severe cases, kidney disease can lead to death.

X. Prediction of kidney diseases in children

The prognosis of kidney diseases in children depends on the type and severity of the disease, as well as on the timeliness and effectiveness of treatment. Early diagnosis and timely intervention can significantly improve the prognosis. Patients with CBP need prolonged observation and treatment to slow down the progression of the disease and prevent complications. Kidney transplantation can improve the quality of life and increase the life expectancy of patients with the terminal stage of CBP.

XI. Psychosocial aspects of kidney diseases in children

Kidney diseases can have a significant impact on the psychosocial well -being of children and their families. A chronic disease can cause stress, anxiety and depression. Dietary restrictions and the need to often visit the hospital can violate everyday life. Parents may feel guilty, anxiety and powerlessness. It is important to ensure psychosocial support to children and families faced with kidney diseases. This may include counseling, support groups and educational resources.

XII. Conclusion

Kidney diseases in children are a serious problem that requires early diagnosis, timely intervention and long -term observation. Understanding the anatomy and physiology of children’s kidneys, the classification of kidney diseases, etiology, clinical manifestations, diagnostic methods, treatment options, preventive measures and potential complications are important for improving the results for children with kidney diseases. Psychosocial support is also crucial for improving the quality of life of children and their families. Constant research and achievements in the field of pediatric nephrology continue to improve the understanding and treatment of these diseases.

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