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Types of kidney problems we treat

There are many types of kidney condition, some present at birth (so-called congenital conditions), and some that develop during childhood and the teenage years.

Information about diagnosis and treatment can be found below. The list does not cover all conditions, but we will work with you to help you develop an understanding of your condition.

List of common conditions

Acute kidney injury

Any acute illness that causes poor kidney function. Examples include infections, bad dehydration, and some drug reactions.

Acute kidney injury in children usually recovers. Treatment depends on severity, but may include treatment of high blood pressure, management of changes in blood salt levels, and occasionally require temporary dialysis treatment.

Chronic kidney disease (CKD)

Kidney disease that does not fully recover, and is long-term. Over time, it often gets progressively worse, and in severe cases may lead to the need for dialysis and/or kidney transplantation.

There are many different causes, but in children the main cause is poor growth and development of the kidneys in the unborn baby, so-called congenital dysplasia (or dysplastic kidneys).

Congenital nephrotic syndrome

A group of rare and serious conditions, presenting in the first few months after birth, involving major leak of protein molecules in the urine. This leads to very low levels of protein in the body, and babies typically come to medical care because they are puffy all over (oedema).

Most of these conditions are genetically inherited, but in almost all cases both parents are healthy – they are carriers of the abnormal gene. There is almost never a 'cure', and most babies will eventually need dialysis and kidney transplantation in early childhood (usually pre-school or early school age).

Cystinosis

A very rare genetic disease, where parents are healthy but carry the abnormal gene.

Patients have an excess accumulation of a certain molecule in their cells, which stops the proper function of certain cells in the body. In infancy and early toddler years, this causes very large loss of fluid and salts in the urine, leading to poor growth and chronic dehydration.

Treatment is based on salt replacement, and drugs to reduce the fluid loss, and a specific drug treatment to help remove the molecule from the cell. Despite modern treatment, many children will eventually need dialysis and kidney transplantation.

Dialysis

The process where medical equipment takes over the role of the kidneys in 'cleaning' the blood, removing waste products and excess fluid from the body, if the kidneys fail and can no longer do this. Children can have dialysis at home, or at hospital.

  • Home dialysis is usually peritoneal dialysis where the child is connected to a dialysis machine overnight, via a plastic catheter inserted into the abdomen. This is usually done every night.
  • Hospital-based dialysis is haemodialysis, where the child is connected to a dialysis machine via an intravenous catheter and the blood is circulated through the dialysis machine. This is usually done three times a week.

We use dialysis to keep the child healthy while we plan and arrange a kidney transplant. A successful transplant means dialysis is no longer needed.

Haemolytic uraemic syndrome

A serious illness causing severe acute kidney injury, nearly always needing dialysis treatment. The symptoms that lead up to kidney failure include diarrhoea with blood in the stool. In the UK, it is usually caused by a form of gastroenteritis caused by a bacterium called E coli 0157: so-called diarrhoea positive (D+) HUS.

Most children with this make a good recovery, although they are very ill for two to three weeks, needing dialysis support and sometimes intravenous feeding if the gastroenteritis has severely affected the bowel.

Rarer forms of HUS may cause recurrent attacks, and may lead to permanent kidney failure.

Henoch schonlein purpura (HSP)

HSP is relatively common.

It causes a blotchy red-purple raised rash (so-called purpura) on the feet, ankles, backs of legs and buttocks. Children commonly have painful feet and ankles, and may have abdominal pain.

It is very common to show small amounts of blood and protein in the urine, detected by a dip stick test.

Most children make a full and rapid recovery. A small percentage of children develop severe acute kidney injury, with poor urine output and high blood pressure, and may need to be supported with dialysis treatment and treated with drugs including prednisolone (a steroid medicine).

Hypertension

High blood pressure is called hypertension. This is much less common in children than in adults, but may be very severe.

The main causes of hypertension in children involve kidney problems, including kidney scarring from infections, acute and chronic kidney disease, and narrowing of the kidney arteries. For this reason, children's nephrology departments are normally involved in diagnosing and treating hypertension in children and teenagers.

Kidney dysplasia

The term given to the problem where kidneys do not form or grow properly in the unborn baby.

Dysplastic kidneys are usually smaller than normal, often contain cysts, and often have reduced function.

Kidney dysplasia is the commonest cause of chronic kidney disease in children.

Nephrectomy

The surgical removal of a kidney.

This is usually done because a kidney is small and poorly functioning, and causing problems like high blood pressure or recurrent infections.

Most nephrectomies in children are done via 'key-hole' surgery.

Nephrotic syndrome

The three features of nephrotic syndrome are:

  1. oedema (puffiness or swelling)
  2. large amounts of protein in the urine
  3. low levels of protein in the blood.

In children, the most common age to develop this is around two to five years old.

Almost 90% of children will show a good response to prednisolone (a steroid medicine). About half of patients will have one or more relapses, where the protein loss returns, and needs treating again.

Children who get several relapses per year are usually treated with additional other drugs, to reduce the amount of prednisolone they are given and to minimise side-effects. A small minority of children have steroid-resistant nephrotic syndrome ( FSGS), or rare early onset forms (congenital nephrotic syndrome).

Posterior urethral valves (PUV)

A congenital blockage in the urethra inside the penis. This is an important cause of kidney and bladder problems in boys.

Treatment includes early minor surgery to remove the blockage, and preventive antibiotics to reduce the risk of urinary tract infection. Some boys may need surgery on the bladder, and some have severe chronic kidney disease and may require a kidney transplant.

Pyelonephritis

Bacterial infection of the kidneys is called pyelonephritis. This is the most severe form of urinary tract infection.

Treatment is with antibiotics, often given intravenously. Ultrasound and other kidney scans are usually performed.

Renal (kidney) artery stenosis

This is narrowing of the artery supplying blood to the kidney. It usually causes very high blood pressure, and is diagnosed during investigations into the cause of this problem.

Systemic lupus erythematosis (SLE or lupus)

The main organs involved include the kidneys, skin, blood, and joints. It is thought to be due to 'attack' on these organs by the patient’s own immune system.

SLE is most common in teenage girls, especially Asian and Afro-Caribbean girls.

Treatment includes prednisolone and other drugs that suppress the immune system. 

Vasculitis

Vasculitis means inflammation of blood vessels. This usually involves small blood vessels that supply the various organs and tissues in the body, including kidneys, joints, and skin, and can lead to problems in these organs and tissues.

Vasculitis of the kidneys typically causes blood and protein in the urine, reduced kidney function, and high blood pressure.

Treatment usually involves drugs including prednisolone (a steroid medicine).

Useful links

More detail about kidney conditions can be found at www.infokid.org.uk.
©  Guy's and St Thomas' NHS Foundation Trust.
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