Renal failure and its accompanying chronic illness always has a profound effect on patients and their families, but can be especially devastating when the patient is a child or adolescent. Not only are the patient's growth and physical development negatively affected by the illness, so are his or her social and psychological development. The dynamics of the family unit are severely strained by a child with chronic renal failure. This is why caring for children with chronic kidney failure requires a team of professionals with highly specialized skills.
Three major categories of illness lead to renal failure in children. Each group of illnesses is responsible for about one-third of this pediatric population. One group includes those children who have renal failure due to congenital structural abnormalities of the urinary tract, including blockage of the kidneys at various levels. These are often detected using fetal ultrasound x-rays. Obstruction of urinary drainage at an early stage of fetal development will cause not only ongoing damage, but also abnormal development of kidney structure. For this reason, correction of the blockage later in life may not reverse damage to the kidneys.
Since one normal functioning kidney is sufficient to support good health, both kidneys must be affected for chronic kidney failure to occur. Posterior urethral valves describes a condition in boys in which a membrane blocks the flow of urine from the bladder. There is a spectrum of disease with this condition, ranging from children stillborn or born with kidney failure, to those with mild conditions who may not have their problems detected until they develop kidney failure during adolescence.
Another congenital structural abnormality which may lead to kidney failure in boys or girls is vesicoureteral reflux, a condition in which urine backs up from the bladder to the kidneys, rather than all being excreted when the bladder contracts. This may lead to kidney damage from repeated infections as well as directly from back pressure.
The second major category causing kidney failure in children is hereditary disease. Alports' Syndrome causes nerve deafness and kidney failure, affecting boys, primarily. It is transmitted from mother to son. There are several other hereditary diseases which lead to cyst formation and then kidney failure in children. Infantile polycystic kidney disease has an autosomal recessive pattern of inheritance (meaning both parents are healthy but carry the trait for the disease in their genes) and may result in kidney failure and liver failure at an early age. Adult polycystic kidney disease has an autosomal dominant pattern of inheritance (meaning one of the parents has the disease) and is misnamed as it may cause kidney failure in infants and children as well as in adults.
The third general category of kidney disease in children includes a group of conditions involving inflammation of the kidneys or glomerulonephritis. In these conditions, the patient's own immune system often is responsible for the damage to the kidneys. These diseases most often affect previously healthy adolescents and older children. Best known of these conditions is systemic lupus erythermatosis, an automimmune disease primarily affecting teenage girls and young women.
Whatever the cause of kidney failure in children, with today's advances in medical technology, and the expertise of a specialized team of professionals, we can often help these children grow up and be healthy, productive members of society.
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