The treatment of pediatric renal insufficiency can be quite complicated. The kidneys play a role in filtering and eliminating waste, maintaining fluid and electrolyte balance, keeping the blood pressure in normal range, producing red blood cells and bone growth. All of these systems may be affected in a child with kidney failure, making treatment challenging. Many complications are managed with medicines and dietary adjustments. Dialysis and kidney transplants may be necessary in advanced cases.
Medical Management
Medical management of the child with kidney disease is focused on preventing and treating worsening kidney function, as well as managing the myriad complications associated with the disease. Dietary strategies to limit phosphorous intake may be necessary, as the kidneys lose their ability to regulate this mineral. In addition, excessive protein intake increases the workload of the kidneys and should be avoided, according to KidsHealth. The same is true for fluids and salt.
High blood pressure may be a cause of or a result of renal insufficiency, even in children. Many patients in this population must take medicines to lower the blood pressure.
Anemia is often a result of kidney failure, due to the loss of a hormone normally produced by the healthy kidney. Shots of this hormone, erythropoietin, may be necessary, notes the National Kidney and Urologic Diseases Information Clearinghouse.
Stunted growth related to renal failure may be treated with human growth hormone administration.
The immune system of a child with chronic kidney disease is often suboptimal. Vaccines for the usual childhood illnesses, plus pneumonia and influenza, are recommended by the National Kidney and Urologic Diseases Information Clearinghouse.
Dialysis
Dialysis is a procedure that substitutes for the filtering of waste by the kidney. Peritoneal dialysis takes place in the abdomen of the child with renal insufficiency. Dialysis fluid is placed inside the abdomen on one side of the peritoneal membrane. Toxins and waste travel through this membrane into the dialysis solution, which is then drained out. This can be done continuously while the child is up and about, or only at night, notes KidsHealth, an information service sponsored by the Nemours Foundation.
Hemodialysis functions on the same principle, but uses a machine to filter the patients blood. This must be done under the close supervision of health professionals, usually three times a week.
Kidney Transplant
About half of kidney transplants in children with renal failure come from a living donor, notes the National Kidney and Urologic Diseases Information Clearinghouse. A transplant may be advised before the need for dialysis arises, a strategy termed preemptive transplantation by the same source. Following kidney transplantation, the patient must take anti-rejection drugs daily. Close medical supervision is then required for life.
