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| Kidney Disease & Children-Act Early To Prevent It! | | | Dr Vijay Kher
Parents of kids who are diagnosed with a chronic kidney disease have many questions about what might happen next, how theirchild might feel, and what treatments are likely to be involved.
Four major areas of concern are blood pressure, diet, anemia (lowred blood cell count), and growth. Kids may feel sick at times, needto take medicines, and watch what they eat and drink.
Read on to learn about treatments for kidney disease and whatparents can do to help.
Treating Kidney Diseases
Treatment begins with diet modification and medicines. Your childmay need to take several medicines, including vitamins, calcium,bicarbonate, and blood pressure pills. As a result, medicationmanagement can be a major challenge.
If your child has difficulty remembering to take medications, considergetting a medicine clock, which has two cardboard clocks - one foreach 12-hour period - with a picture of the medicines posted on thethe times they need to be taken. These clocks can provide valuablecues for kids who need to take several doses of different medicinesthroughout the day and evening. Also, alarms can be set to remindkids to take their medicine.
If your child must take so much medicine that it affects his or herappetite, contact your doctor for advice. Try to find the mostacceptable forms of medicine (smaller pills, capsules, or moreconcentrated liquids, for example) and simplify the medicationschedule under your doctor's guidance.
Injectable medicines are available for treatment of anemia and growth faliure in some kids with chronic kidney disease.Erythropoetin can increase the red blood cell count, which oftenimproves energy and activity levels in kids with kidney failure. Manykids with chronic kidney disease will grow more normally with thehelp of human growth hormone injections.
Children with chronic kidney failure may not have any symptomsuntil about 80% of their kidney function is lost. Then, they may feeltired, have nausea or vomiting, have difficulty concentrating, orexperience confusion. Accumulated fluid appears as swelling in theskin, fluid congestion in the lungs, and high blood pressure . At thisstage, two treatment options are available - dialysis and transplant.
Dialysis
Nearly all kids with end-stage kidney disease eventually receivetransplants. If a living related donor can't be found, dialysis may berequired until a donor kidney becomes available.
The two forms of dialysis are hemodialysis and peritoneal dialysis:
1. In hemodialysis, blood is cleansed outside the body through amachine. These treatments take several hours at a time andusually need to be performed three or more times a week. Inmost cases, hemodialysis is done in a dialysis center, but in somecases it can be done at home.
2. Peritoneal dialysis uses the body's own peritoneal membrane -beneath the outer layers of the abdominal wall - to filter theblood. Two forms of peritoneal dialysis are available: continuouscycling peritoneal dialysis (CCPD) and continuous ambulatoryperitoneal dialysis (CAPD). CCPD uses a simple machine called acycler to perform the dialysis at night; CAPD is done throughoutthe day and no machine is needed. CCPD requires the assistanceof a parent and is most suitable for younger children; CAPD isperformed by the patient and may be more suitable for older kidsand teens.
Both types of dialysis, but particularly hemodialysis, require that dietbe limited with regard to fluids, phosphorus, and salt intake. Withfewer dietary and fluid restrictions, peritoneal dialysis canmean more lifestyle flexibility, and children tend to grow better.
Helping Your Child
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 carbohydrates and fats might help to increase calorie intake.
The kidneys cannot easily remove excess water, salt, or potassium, so their intake might need to be limited. Dairy products have to be restricted because they contain lots 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. While avoiding excessive protein intake is advisable and will also help limit phosphorus intake, it's important to remember that kids do need enough protein for growth - so strict protein restriction (the kind recommended for adult patients) should not be used.
You'll also need to monitor fluid intake. If your child's ability to produce urine is declining, fluid intake needs to be limited. Stay away from "super-size" drinks, and offer slushy beverages or ice cubes to suck on.
Sodium
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. Be careful of salt substitutes, too. Many salt substitutes have potassium in them, too much of which can cause problems for kids with kidney failure. Some other salt preparations (for example, "natural salts," Himalayan salts, etc.) are just as high in sodium chloride as common table salt.
Read food labels and talk to your doctor or a dietitian 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 minimizing damage to kidneys and avoiding other complications.
Exercise
Exercise will help your child perspire to get rid of excess fluid and flush out toxins through the skin. Keep TV and video games to a minimum and encourage physical activity instead. Walking and Strength training make bones stronger and stimulate muscles and nerves that can help ease "restless leg syndrome" and other nervous system problems sometimes associated with kidney disease.
Emotions
Beyond these 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. You may find contacts and support groups through your nephrologist or the National Kidney Foundation. It's important for kids to see that the symptoms of the disease can be managed and controlled and that they can live a full life.
Kids whose health is stable should be encouraged to participate as fully as possible in school and activities, which will help them develop their self-esteem.
During hemodialysis treatments, doing homework, reading, and working on art projects are some positive ways to spend the time. (One pediatric dialysis patient said she appreciated the special lunches her mother prepared before her treatments, when she could ease up a little on the protein, sodium, and potassium restrictions.)
Looking Ahead
As kids with chronic kidney diseases get older, they can take on more responsibility for their own care. School-age kids should know the names of their medicines and how and when they're taken. As they're making the transition to adulthood, teens can share in the responsibility of making appointments. Teens should also have time alone to speak with the doctor and other members of the health care team.
A big step for kids is being able to talk to others - such as teachers, coaches, and friends - about their condition. Teens especially don't want to stand out or seem different. Part of the process of learning and maturing will be identifying limitations and knowing when to ask for help.
Kids with chronic kidney disease might also have problems dealing with the side effects of medicines. For those taking prednisone for long periods of time, these effects can be significant, including weight gain (especially around the face and trunk), moodiness, sleep disturbances, cataracts, and osteoporosis (weakening of the bones). Long-term treatment with these medications also can slow growth and delay pubertal maturation.
Long-term prednisone treatment can lead to or aggravate acne in teens. To an adolescent dealing with body image, a clear complexion might be just as important as controlling the kidney disease.
Besides the stress of having a chronic illness, your child is going through all of the trials and tribulations of growing up as experienced by all kids. Treat him or her as a child first, which includes establishing standards of behavior. Sometimes, those standards have to be relaxed or suspended during particularly difficult times; the trick is picking them up again after your child's health improves.
Keep the lines of communication open so everyone knows what's happening and never hesitate to ask for help from your doctor or a mental health professional if you think it might be needed.
(This Article is provided in Public Interest by Dr Vijay Kher Chairman-Medanta Kidney Institute, Medanta The Medicity Gurgaon Under Deptt of Community Outreach Programme) |
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