Kidney Failure in Children

What are the signs of kidney failure in children?

Sometimes there are no signs of kidney failure. When kidney failure is mild, it often goes undetected unless doctors do testing for another reason. Signs also depend on the cause of the kidney failure.

Typical signs of kidney failure can include:

• Decreased urine output
• Fluid retention, leading to body swelling
• Decreased energy
• Paleness caused by anemia (a low level of red blood cells)

Additional, non-specific symptoms can include:

• Poor appetite
• Vomiting
• Headaches
• Stunted growth
• Urinary tract infections
• Incontinence (inability to hold urine)
• Fever
• Rash
• Bloody diarrhea
• Abdominal mass (a noticeable lump in the abdomen)

What tests do we use to diagnose kidney failure in children?

After discussing your child’s medical history and doing a physical exam, additional tests may include:

• Blood work to test kidney function
• Urine testing to check protein levels
• Imaging (usually ultrasound) to look at the kidneys and urinary tract, and detect any blockages, masses or abnormalities
• A kidney biopsy, if we need a small sample of kidney tissue to diagnose a problem or check its condition

What to expect from a kidney biopsy

A kidney biopsy is when we take a small sample of kidney tissue to look at under a microscope. We can do this on an outpatient basis, meaning your child does not need to stay in the hospital overnight.

Your child should have an empty stomach before this procedure. We will place an IV, which is a thin tube that delivers medicine, directly into a vein. We will also provide sedation (light sleep) or full anesthesia (complete unconsciousness). This decreases stress and pain as much as possible.

We insert a needle through your child's back onto the surface of the kidney and watch our movements using ultrasound. We then remove a few small pieces of kidney tissue (about half an inch in length and between a hair and a spaghetti noodle in thickness). We then process and stain the tissue to enhance its appearance under a microscope, and study it, which takes a few days.

The kidney biopsy usually lasts about 60 minutes. Your child will then wake up from the anesthesia, and we will monitor them for several hours to watch for any bleeding or other problems. When your child goes home, they will need to avoid strenuous activities for several days. We will instruct parents to call about any concerns or changes.

When we have the biopsy results a few days after the procedure, we will discuss them with your family and develop a personalized treatment plan together.

How do we diagnose kidney failure in children?

We diagnose kidney failure by considering your child's symptoms and test results. Blood and urine tests are most common, followed by imaging and then biopsy.

How is kidney failure treated in children?

Treatment depends on the cause of the kidney failure, on whether it is acute or chronic, and – most importantly – on how severe it is. It also depends on your child's tolerance for certain therapies, and your preferences as a family.

Treatments may include monitoring, medicines and diet changes. When a child's kidney failure is severe, treatment may include dialysis, in which we use a machine to filter waste and water from their blood.

As a final measure, some children with the most severe, chronic kidney failure will need a kidney transplant. This is when we replace one of their kidneys with a healthy kidney donated by another person, living or deceased. One good kidney is enough to keep a person reasonably healthy.

What's life like after a kidney transplant?

Once these patients recover from their transplant surgery, we expect kids who get kidney transplants to live full, normal lives.

They will need to take medicine for the rest of their lives to make sure their body's immune system doesn't fight their new kidney, and they will need regular follow up with laboratory testing.

Why choose Children's Colorado for kidney failure treatment?

Our pediatric kidney care team has vast experience in caring for children with kidney disorders. We are a multidisciplinary group of doctors, nurses, dietitians, social workers and other pediatric professionals providing child-centered care. We also have the only pediatric dialysis and Kidney Transplant Program in the region. This makes us the optimal choice for comprehensive kidney care in children.

In addition, we work closely with our Fetal Care Center, where we can sometimes detect kidney issues even before birth. We also collaborate with other specialties like our Department of Pediatric Urology, where we manage conditions together that involve the kidneys and the lower urinary tract. A common example for such conditions is congenital anomalies of the kidneys and the urinary tract (CAKUT).

• The Kidney Center at Children's Colorado treats children and teens with kidney problems. Contact us at 720-777-6263 or schedule an appointment online.
• Our Pediatric Nephrology Research page shows our latest news and documents for patient referrals.
• We work closely with our Department of Pediatric Urology for children with urologic conditions.
• The National Kidney Foundation works toward the awareness and treatment of kidney disease.
• The National Institute of Diabetes and Digestive and Kidney Diseases researches treatment.