According to the National Institute for Diabetes, Digestive and Kidney Diseases (NIDDK), chronic kidney or renal failure in children leads to other health problems like body swelling, growth failure and bony deformities. The long term nature of this illness and its emotional impact on children is also quite remarkable. The Mayo clinic says that there is no cure for chronic renal failure. Treatment options are all aimed at improving quality of life, slowing the progression of the disease where possible and minimizing complications.
Dialysis
The kidneys remove waste products and excess water from the body. This function is replaced by dialysis in children with chronic renal failure. Because there are different approaches to dialysis, the decision of which type to use is made on a case by case basis.
In peritoneal dialysis, the inner lining of the child's abdomen, called the peritoneum, is used to filter the blood. According to the NIDDK, a tube is inserted in the abdomen and a fluid, called a dialysate, is introduced in to the abdomen, where it stays for a while to draw out toxic waste, chemicals and excess water. The dialysate is drained afterward, and the cycle is repeated several times in a day. With careful instruction, older children or parents can perform this kind of dialysis. According to the Nemours Foundation, this affords a more flexible lifestyle to the children and their parents.
There are two types of peritoneal dialysis. Continuous Cycling Peritoneal Dialysis (CCPD) uses a machine called a cycler to run the cycles of dialysis throughout the night and is more suitable for parents of younger children to run, says the Nemours Foundation. Continuous Ambulatory Peritoneal Dialysis (CAPD) is done throughout the day and is preferred for older children and teens.
Hemodialysis usually requires some form of hospitalization. According to the NIDDK, in this type of dialysis the child's blood travels through one set of tubes to a dialyzer that cleanses the blood of waste and maintains the proper balance of chemicals and water. The cleansed blood travels back to the child's body via another set of tubes. Hemodialysis typically requires three sessions of 4 to 6 hours each every week, though more sessions may be required in smaller children, says the NIDDK. Some sessions may be done at home under stringent regulations and after rigorous training of the caregiver.
Transplantation
Transplantation gives the child a healthy kidney, which, if accepted, replaces the need for dialysis. The source of the healthy kidney for a transplant is usually someone who just died, but a considerable number of transplanted kidneys come from living family members of the child says the NIDDK.
After a kidney transplant, several medications, a strict diet and regular checkups are necessary to ensure the new kidney is accepted and functions properly.
Medications and Diet
Vaccines and immunization are required to prevent disease in chronic renal failure patients because the toxic waste products that build up can suppress the immune system, according to the NIDDK. Children with chronic renal failure should have all required childhood vaccines in addition to vaccines for pneumonia and influenza. Children on immune suppressant therapy, either to treat the conditions that damaged the kidneys in the first place or to protect the newly transplanted kidneys, are not to receive vaccines containing live organisms, like measles, mumps, rubella, MMR, vaccines and chicken pox.
Certain drugs are also given to treat complications of chronic renal failure. Angiotensin Converting Enzyme Inhibitors, ACEIs, and Angiotensin Receptor Blockers, ARBs, are prescribed to control blood pressure, says the Mayo Clinic. Diuretics are prescribed to relieve fluid collection and body swelling. Erythropoietin, a hormone that stimulates the bones to produce red blood cells, is given by injections to combat anemia. According to the NIDDK, phosphate binders may be given to children with chronic renal failure to reduce the blood levels of phosphorus and improve bone health.
Immune supressant drugs are usually given after a transplant to facilitate the acceptance of the donor kidney by the child's body.
A very strict diet is encouraged at all times for anyone with chronic renal failure. According to the NIDDK, the special diet should involve foods low in salt and phosphorus and some fluid restriction.
