While chronic kidney disease (CKD) is a common condition in adults in the U.S., it is very rare in children. The fellowship-trained, board-certified pediatric nephrologists with Norton Children’s Nephrology, affiliated with the UofL School of Medicine, have the training and experience to treat children with CKD. Our kidney specialists can work with you and your child to improve symptoms and limit damage to the kidneys.

What Is Chronic Kidney Disease?

Most people are born with two kidneys. The kidneys filter waste and excess liquid from the blood. CKD is the term used for permanent damage to kidneys that occurs and worsens over time.

CKD is different than acute kidney injury (AKI) because while AKI can happen suddenly, CKD happens when kidney function decreases over time and the damage is permanent. CKD is diagnosed when kidneys are experiencing issues for three months or longer and do not improve.

Chronic Kidney Disease Stages

The stages of CKD are determined by glomerular filtration rate (GFR). This measurement shows how effective the kidneys filter blood. The National Kidney Foundation refers to the five stages of CKD as:

• Stage 1: Kidney damage with normal or increased GFR (greater than 90)
• Stage 2: Kidney damage with mild decreased GFR (60 to 89)
• Stage 3: Moderate decreased GFR (30 to 59)
• Stage 4: Severe increased GFR (15 to 29)
• Stage 5: Kidney failure (GFR less than 15); stage 5 is considered end-stage renal disease

These stages are considered guides, and each child may have different symptoms and issues. Since CKD is a progressive condition, many who experience it will eventually reach stage 5. However, there are therapies that can slow progression and minimize complications.

What Causes Kidney Disease?

CKD can be caused by any condition that can damage the kidneys, including:

• Congenital anomalies of the kidneys and urinary tract (differences in the kidneys or urinary tract that children are born with)
• Certain types of cancer
• Glomerulonephritis
• High blood pressure (hypertension)
• Kidney conditions such as polycystic kidney disease
• Lupus or other autoimmune diseases
• Recurring infections
• Type 1 diabetes
• Type 2 diabetes

Signs of Kidney Disease

In early stages, there may be no noticeable symptoms. However, as kidney function declines, symptoms can appear and may include:

• Dry, itchy skin
• Feeling tired or unwell
• Loss of appetite
• Muscle cramps
• Nausea
• Need to urinate more frequently, especially at night
• Shortness of breath
• Swelling in the hands, feet or near the eyes
• Trouble concentrating
• Vomiting

Chronic Kidney Disease Treatment

CKD treatment is based on a child’s age, current health and stage of chronic kidney disease. Treatments focus on limiting and potentially stopping the progression of kidney damage. Conditions that may cause the kidney damage, such as diabetes or high blood pressure, are treated as well.

Treatments can include:

• Antibiotics to prevent kidney infections
• Dialysis
• Diet and exercise modifications
• Erythropoietin (EPO) shots
• Growth hormones (children with CKD can have trouble growing)
• Insulin therapy (if diabetes is a factor in CKD)
• Kidney transplant
• Medicines to manage high blood pressure, such as ACE inhibitors or angiotensin II receptor blockers (ARBs)
• Medicines that prevent the body from absorbing calcium and phosphorous
• Surgery to address any congenital differences in the urinary tract or kidneys