When Your Child Has a Chronic Kidney Disease (KidsHealth.org)

Once your child has been diagnosed with a chronic kidney disease, it may help to know what could happen next - how your child might feel and what treatments might be involved. Four major areas of concern for parents of kids with kidney diseases are the child's blood pressure, diet, anemia (low blood count), and growth. Your child may frequently feel sick and may need to take medicines and be careful about what he or she eats and drinks. For you, that can mean a greater need for involvement in your child's life. Keep reading to learn about treatment for your child's kidney disease and what you can do to help.

Treating Kidney Diseases Treatment begins with diet modification and medicines. Your child may need to take several medicines, including vitamins, calcium, bicarbonate, and blood pressure pills. As a result, medication management may be a major challenge.

If your child has difficulty remembering to take his or her medicine, you might want to get a medicine clock, which is made up of two cardboard clocks - one for each 12-hour period - with a picture of the medicines on the faces of the clocks at the times the medications need to be taken. These clocks can provide a valuable cue for a child who needs to take several doses of different medicines throughout the day and evening. Also, alarm watches can be set to remind your child to take his or her medicine.

If your child needs to take so much medicine that he or she feels full and doesn't want to eat as much, ask your child's doctor for suggestions. Try to find the most acceptable forms of medicine (smaller pills, capsules, or more concentrated liquids, for example) and simplify your child's medication schedule under the doctor's guidance as much as possible.

Newer injectable medicines are available for treatment of anemia and growth failure in some children with chronic kidney disease. Erythropoetin can increase the red blood cell count, which often improves the energy and activity levels of a child with kidney failure. Recent studies have shown that many children with chronic kidney disease will grow more normally with the help of human growth hormone injections.

Children with chronic kidney failure may not have any symptoms until about 80% of their kidney function is lost. Then, they may feel tired, have nausea or vomiting, have difficulty concentrating, or experience confusion. Accumulated fluid appears as swelling in the skin, fluid congestion in the lungs, and high blood pressure. At this stage, two treatment options are available - dialysis and transplant.

Nearly all children with end-stage kidney disease eventually receive transplants. If a living related donor can't be found, dialysis may be required until a donor kidney is found.

The two forms of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, blood is cleansed outside the body through a machine. These treatments can take 4 hours at a time and need to be performed two to three times a week. Hemodialysis requires that a child's diet be limited with regard to fluids, phosphorus, and salt intake. Peritoneal dialysis uses the body's own peritoneal membrane - beneath the outer layers of the abdominal wall - to filter the blood. It requires fewer dietary and fluid restrictions and offers more lifestyle flexibility. Two forms of peritoneal dialysis are available: one uses a simple machine to perform the dialysis at night (CCPD), whereas the other is done throughout the day (CAPD). CCPD requires the assistance of a parent and is most suitable for younger children; CAPD is performed by the patient and may be more suitable for an older child.

Helping Your Child A child with chronic kidney disease may have several needs to address, including diet changes. Ensuring that your child takes in adequate calories and proper amounts of various nutrients can be a challenge for both you and your child. Supplementing your child's diet with extra carbohydrates and fats may help to increase calorie intake.

As kidney failure develops, it produces a taste in the mouth that leads to an aversion to certain foods, especially proteins. Dairy products have to be restricted because they contain large amounts of phosphorus. But if they're eliminated, it can be difficult to provide enough calcium in your child's diet to maintain bones and support other body needs, particularly in a growing child.

In children with more severe degrees of 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 put off the need for dialysis. It's important to remember that children do need enough protein for growth, and strict protein restriction (the kind that's recommended for adults) should not be used. Avoiding excessive protein intake is advisable, though, and will also help limit phosphorus intake. Too much phosphorus may lead to calcium deposits in the eyes, heart, skin, and joints and may weaken the skeleton, which can increase the risk of broken bones.

Many foods (including fruits and vegetables) contain potassium, but too much of it can be dangerous for children with kidney failure. Foods that are high in potassium include orange juice, bananas, tomato sauces, raisins, and melons.