Kidney Problems

What are kidney problems?

Kidney problems occur when the kidneys do not work as they should. Some kidney problems happen suddenly. This is known as acute kidney injury. Other kidney problems develop slowly over time. This is known as chronic kidney disease. In severe cases, kidney disease can lead to kidney failure, where the kidneys stop working. 

Certain diseases or their treatments can cause kidney problems, which may be short- or long-term. 

Talk to your care team about your child’s risk for kidney problems and ways to protect kidney health. 

How the kidneys work

The kidneys are 2 organs located below the rib cage on each side of the spine. They are shaped like beans and are about the size of your fist. You might hear the terms renal, nephro-, or nephron, which mean relating to the kidneys.

The kidneys filter the blood. They remove waste and extra liquid to make urine (pee). Urine flows from the kidney through 2 tubes, called ureters, which drain into the bladder. Urine is stored in the bladder and emptied from the body through the urethra. The kidneys, ureters, and bladder are part of a system called the urinary tract.

Good kidney function is important to prevent health problems. The kidneys help to:

• Regulate fluids in the body
• Remove waste from the blood
• Balance salt, potassium, and other chemicals
• Make hormones that control blood pressure and red blood cell formation

Symptoms of kidney problems

Many kidney problems do not cause symptoms until kidney disease is more advanced.

Signs and symptoms of kidney problems may include:

• Increase or decrease in urine (pee)
• Foamy appearance of the urine
• Change in color of urine
• Urgent need to pee, not being able to control pee, bed wetting
• Pain or burning when peeing
• Pain in the back or abdomen
• Swelling in hands, legs, feet, or face
• Feeling tired or weak
• Itchy skin
• Fever
• Trouble concentrating
• Nausea or vomiting
• Loss of appetite
• Weight loss or delayed growth
• Trouble breathing or shortness of breath
• Irregular heartbeat
• Urinary tract infections
• High blood pressure (hypertension)
• Low red blood cell count (anemia)
• Protein in your urine
• Blood in your urine (hematuria)

Causes of kidney problems

Medical conditions and diseases

Kidney problems can be caused by medical conditions such as:

• Diabetes
• High blood pressure
• Autoimmune diseases
• Infection, including urinary tract infection (UTI)
• Inherited kidney disease (passed down from parents)
• Kidney reflux (backward flow of urine)
• Dehydration (losing too much water)
• Kidney cancer such as Wilms tumor and renal cell carcinoma
• Sickle cell disease

Children with sickle cell disease can develop sickle cell kidney disease. This happens when sickled red blood cells block the flow of blood and oxygen in and around the kidneys leading to kidney damage.

For children with cancer or other serious illnesses, medical treatments such as radiation, chemotherapy, other medicines, contrast dye used for imaging exams, and surgery may cause kidney problems and, in some cases, damage the kidneys.

Radiation

Radiation treatments near the kidney area or abdomen (belly), and total body irradiation can cause kidney damage.

Chemotherapy and other medicines

The kidneys filter blood, which helps remove medicines from the body. Some medicines can harm the kidneys. This is more likely if your child receives high doses of medicine for a long time, or takes several medicines at once.

Medicines more likely to cause kidney problems include:

• Cisplatin
• Carboplatin
• Ifosfamide
• Methotrexate
• Antibiotics such as tobramycin, gentamicin, and amphotericin
• Non-steroidal anti-inflammatory drug (NSAID) pain relievers such as aspirin, ibuprofen, and naproxen sodium
• Medicines for graft-versus-host disease (a complication of stem cell transplant). These medicines include:
  • Steroids
  • Calcineurin inhibitors (cyclosporine and tacrolimus)
  • Medications that help control the immune system response (immunosuppressants)

Surgery

Damage or scar tissue after kidney surgery may happen in the ureter, bladder, or nearby blood vessels. This can lead to kidney problems for some patients.

Patients who have surgery to remove part or all of a kidney are at risk for kidney problems later in life. It is important to know that people with only 1 healthy kidney can live normal lives and still have good kidney function.

Bone marrow (stem cell) transplants

Bone marrow (stem cell) transplants may cause kidney problems later in life.

Patients who had bone marrow transplants should talk to their health care provider about their risk for kidney problems. Cancer survivors should share a copy of their survivorship care plan with all health care providers.

Organ failure

Kidney problems may occur following the failure of other organs, such as the heart and liver, which may happen from a disease, infection, injury, or very low blood pressure (shock).

Tests for kidney problems

If your child is at risk for kidney problems, your care team will do tests to find out if their kidney function has changed and is not normal. Tests may include:

• Physical exam and health history: Your care team will ask questions and do tests to learn about kidney disease risk factors including medications, diabetes, and high blood pressure. Because kidney disease can be passed down through families, the care team will also ask questions about your family’s health history.
• Urine tests (urinalysis): Your health care provider will collect a urine sample to test the urine for sugar, protein, blood, and bacteria. A urine test will also look for albumin, a protein found in urine when kidneys are damaged.
• Blood tests such as:
  • Glomerular filtration rate (GFR): The GFR measures how well the kidneys filter the blood to remove waste, toxins, and fluid. A low GFR may mean that your child’s kidneys are not working properly.
  • Blood urea nitrogen (BUN): Urea nitrogen is made when the body breaks down proteins from food. The kidneys normally filter urea nitrogen from the blood. A high BUN level may signal a kidney problem.
  • Serum creatinine: Creatine is a waste product of the body’s muscles. Creatinine levels measure how well kidneys filter waste from the blood. Your child may have an increase in creatine in the blood if the kidneys are not working well.
  • Electrolyte tests: Electrolytes are minerals that help the body function. These include sodium, chloride, magnesium, potassium, and calcium. High or low levels can be a sign of kidney problems.
  • Cystatin C: This test measures the amount of the cystatin C protein in your child’s blood. A high level of cystatin C may mean that your child’s kidneys do not work well.
• Imaging tests: A nuclear medicine scan or scans of the kidney using ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) can show kidney damage or blockage of blood vessels.
• Kidney biopsy: Your care team may do a kidney biopsy if they suspect that your child has a tumor in the kidney. This is a procedure to remove a small piece of tissue to be examined under a microscope. In rare cases, the care team may do a biopsy if the cause of kidney injury or damage is unknown.
  

Treatment of kidney problems

Treatment for kidney problems depends on their cause and your child’s medical needs. Some kidney problems are mild and short-term while others can be severe or long-lasting.

Your care team might include specialists such as a nephrologist or urologist. A nephrologist is a doctor who specializes in the diagnosis and treatment of kidney disease. A urologist is a surgeon who diagnoses and treats conditions of the urinary tract.

In most cases, kidney problems are cared for by treating the cause of the problem. People who have severe kidney disease or kidney failure may need:

• Fluids
• Adding new medicines or removing ones that cause kidney problems
• Changes in diet
• Enteral nutrition (tube feeding)
• Dialysis or a kidney transplant
  • Dialysis is a procedure that uses a machine to do the work of the kidneys. The machine filters waste and fluid from the blood. This usually takes place at a special dialysis center and happens regularly, often a few times a week. The patient will continue getting dialysis until the problem is fixed or they get a kidney transplant.
  • A kidney transplant is a surgery to replace a patient’s damaged kidney with a healthy one from a donor. A kidney transplant is a major surgery that is used only when other treatments have not worked well or if the patient’s condition gets worse.

Prognosis for kidney problems

The prognosis for kidney problems depends on what is causing the problem and the patient’s response to treatment. 

Chronic kidney problems, treatment, and dialysis can affect quality of life. Children with chronic kidney problems may have problems with normal development and growth. These challenges may continue into adulthood. Severe kidney problems may affect your child’s lifespan. Your child's doctor is the best source of information about your child's case.

Tips for families

Know your child’s risk for kidney problems

If your child has kidney problems, it is important that they get medical care to help prevent further complications. Some steps you can do to help are:

• Talk to your care team about your child’s risk for kidney problems.
• Have a yearly physical exam.
• Have regular blood pressure checks.
• Have blood tests and urine for kidney function, as recommended by your health care team.
• Keep track of your child’s results and know the healthy ranges for lab tests.
• Patients who had kidney or bladder surgery should see a specialist at least once a year, or as recommended.

Take steps to keep your child’s kidneys healthy

• Follow your care team’s instructions about what your child can eat and drink.
• Ask your care team before you give your child any new medicines, vitamins, or other supplements.
• Drink plenty of water. This is especially important during physical activity or in hot weather.
• Limit caffeine and alcohol intake.
• Contact your care team right away if your child has symptoms of a kidney or urinary tract infection. Symptoms may include:
  • Belly or back pain
  • Pain or burning while urinating (peeing)
  • Urinating more than usual
  • Feeling an urgent need to pee.
• Ask your doctor before using non-steroidal anti-inflammatory drugs (NSAIDs). These medicines include aspirin, ibuprofen, and naproxen. They can cause kidney damage. This is especially true in large doses when used often, or when taken with other medicines.
• Encourage healthy toilet routines. Holding in pee for too long or not emptying the bladder when peeing can cause kidney problems.
• Make sure your child gets enough exercise and stays a healthy weight for their age.
• Get vaccinations recommended by your care team.

Questions to ask your care team 

• Is my child at risk for kidney problems?
• What screenings or monitoring does my child need?
• What signs and symptoms should I look for?
• When should I call my health care provider?
• What can I do to lower my child’s risk of having kidney problems?
• What medicines should my child avoid?
• What changes in food and drink are needed? Do I need to monitor my child’s fluid intake?

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