Overview of Kidney
 

Diseases in Children
 What are the kidneys, and

what do they do?

The kidneys are two bean­shaped organs

located near the middle of the back, just

below the rib cage.  When blood flows

through the kidneys, waste products and

extra water are removed from the blood

and sent to the bladder as urine.  The kidneys also regulate blood pressure, balance

chemicals like sodium and potassium, and

make hormones to help bones grow and

keep the blood healthy by making new red

blood cells.

Who is at risk?

In the general population, slightly more

than 30 people in every 100,000 develop

kidney failure each year.  In the pediatric

population—age 19 and under—the annual

rate is only 1 or 2 new cases in every

100,000 children.  In other words, adults

are about 20 times more likely to develop

kidney failure than children.  The risk

increases steadily with age.

African Americans in their late teens are

three times more likely than whites in the

same age group to develop kidney failure.

Diseases that damage the tiny blood vessels

in the kidney are also more common in

children of color. Moreover, boys are nearly twice as likely as girls to develop kidney

failure from birth defects, polycystic kidney

disease, or other hereditary diseases.

What are the causes of kidney

failure in children?

Kidney failure may be acute or chronic.

Acute diseases develop quickly and can be

very serious.  Although an acute disease

may have long­lasting consequences, it

usually lasts for only a short time and then

goes away once the underlying cause has

been treated.  Chronic diseases, however,

do not go away and tend to get worse over

time.  When the kidneys stop working,

doctors use a treatment called dialysis to

remove waste products and extra water

from patients with chronic kidney failure.

Acute Kidney Diseases

Acute kidney disease may result from an

injury or from poisoning.  Any injury that

results in loss of blood may reduce kidney

function temporarily, but once the blood

supply is replenished, the kidneys usually

return to normal.  Other kinds of acute

kidney disease in children are

■	 Hemolytic uremic syndrome. This rare

disease affects mostly children under 10

years of age and can result in kidney

failure.  Eating foods contaminated by

bacteria leads to an infection in the

digestive system, which in the first

stages causes vomiting and diarrhea.

When these symptoms subside, the child

is still listless and pale.  Poisons produced by the bacteria can damage the

kidneys, causing acute kidney failure.

Children with hemolytic uremic syndrome may need blood transfusion or

dialysis for a short time.  Most children,

National Institute of Diabetes and Digestive and Kidney Diseases

NATIONAL INSTITUTES OF HEALTH

U.S. Department of Health

and Human Services
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however, return to normal after a few

weeks.  Only a small percentage of children

(mostly those who have severe acute kidney

disease) will develop chronic kidney disease.

■	 Nephrotic syndrome. A child with this syndrome will urinate less often, so the water

left in the body causes swelling around the

eyes, legs, and belly.  The small amount of

urine the body makes contains high levels of

protein.  Healthy kidneys keep protein in

the blood, but damaged kidneys let it leak

from the blood into the urine.  Nephrotic

syndrome can usually be treated with prednisone to stop protein leakage, and sometimes a diuretic is used to help the child

urinate and reduce the swelling.  Usually, the

child can take smaller and smaller doses of

prednisone and eventually return to normal

with no lasting kidney damage.  This temporary condition is called minimal change disease.  Relapses are common but usually

respond to prednisone treatment.

Chronic Kidney Diseases

Unfortunately, the conditions that lead to chronic

kidney failure in children cannot be easily fixed.

Often, the condition will develop so slowly that it

goes unnoticed until the kidneys have been permanently damaged.  Treatment may slow down

the progression of some diseases, but in many

cases the child will eventually need dialysis or

transplantation.

■	 Birth defects. Some babies are born without

kidneys or with abnormally formed kidneys.

The kidney abnormality is sometimes part of a

syndrome that affects many parts of the body.

■	 Blocked urine flow and reflux. If blockage

develops between the kidneys and the opening

where urine leaves the body, the urine can back

up and damage the kidney.

■	 Hereditary diseases. In polycystic kidney disease (PKD), children inherit defective genes

that cause the kidneys to develop many cysts,

sacs of fluid that replace healthy tissue and

keep the kidneys from doing their job.  In

New cases, by age, per million population, adjusted for gender and

race.

Source: United States Renal Data System. 2005 Annual Data Report:

Atlas of End­Stage Renal Disease in the United States. 2005.

Alport syndrome, the defective gene that

causes kidney disease may also cause hearing

or vision loss.

■	 Glomerular diseases. Some diseases attack the

individual filtering units in the kidney.  When

damaged, these filters—which are called

glomeruli—leak blood and protein into the

urine.  If the damage to the glomeruli is severe,

kidney failure may develop.

■	 Systemic diseases. Diabetes and lupus can

affect many parts of the body, including the

kidneys in some people.  In lupus, the immune

system becomes overactive and attacks the

body’s own tissues.  Diabetes leads to high levels of blood glucose that damage the glomeruli.

Diabetes is the leading cause of kidney failure

in adults.  In children, however, diabetes is low

on the list of causes because it usually takes

many years of high blood glucose for the kidney disease of diabetes to develop.  However,

an increasing number of children have type 2

diabetes, which is usually associated with

adults.  As a result, we may see more children

with chronic kidney failure caused by diabetes

in the future.

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From birth to age 4 years, birth defects and

hereditary diseases are by far the leading causes

of kidney failure.  Between ages 5 and 14 years,

hereditary diseases continue to be the most common causes, followed closely by glomerular diseases.  In the 15­ to 19­year­old age group,

glomerular diseases are the leading cause, and

hereditary diseases become rarer.

What are the treatments

for kidney failure?

A child whose kidneys fail completely must

receive treatment to replace the work the kidneys

do.  The two types of treatment are dialysis and

transplantation.

Dialysis

Dialysis is a way to remove the waste products

and extra water from the blood of patients with

kidney failure.  The two main types of dialysis are

peritoneal dialysis and hemodialysis.

■	 Peritoneal dialysis. This method uses the lining

of the child’s abdominal cavity, the peritoneum,

as a filter. A catheter placed in the child’s belly

is used to pour a solution containing dextrose

(a sugar) into the abdominal cavity. While the

solution is there, it pulls wastes and extra fluid

from the blood. Later, the solution is drained

from the belly, along with the wastes and extra

fluid. The cavity is then refilled, and the cleaning process continues. Peritoneal dialysis can

be performed in the home, usually while the

child sleeps, without a health professional present. You and your child will receive extensive

training before you start home treatments.

■	 Hemodialysis. This method uses a machine

that carries the child’s blood through a tube to

a dialyzer, a canister that contains thousands of

fibers that filter out the wastes and extra fluid.

The cleaned blood is then returned to the child

through a different tube.  Hemodialysis is usually performed in a clinic under the supervision

of a nurse and kidney specialist.  It is generally

required three times a week for about 3 to 4

hours each time.

Transplantation

Transplantation provides the closest thing to a

cure for kidney failure.  In this procedure, a surgeon places a healthy kidney in the child’s body.

The kidney may come either from a living donor

or from someone who has just died.

■	 Living donor. Most people can donate a

kidney without hurting their health.  Many

children receive a kidney from one of their

parents, but the donor does not have to be a

family member.

■	 Deceased donor. If no living donors are available, a child may be placed on a waiting list to

receive a kidney from someone who has just

died.  The United Network for Organ Sharing

(UNOS) maintains a computerized system for

matching kidneys with appropriate recipients.

People who have transplants must take drugs to

keep the body’s immune system from rejecting the

new organ.  These immunosuppressive drugs can

help maintain good function in the transplanted

kidney for many years.  However, they may have

some undesirable side effects such as making a

child vulnerable to infections.

For more information about dialysis and transplantation, see the National Institute of Diabetes

and Digestive and Kidney Diseases (NIDDK) fact

sheet Treatment Methods for Kidney Failure in

Children.

Hope Through Research

Through its Division of Kidney, Urologic, and

Hematologic Diseases, the NIDDK supports several programs and studies devoted to improving

treatment for patients with progressive kidney

disease and kidney failure.  The NIDDK maintains the Pediatric Nephrology Program, which

supports research into the causes, treatment, and

prevention of kidney diseases in children, including congenital malformations of the urinary tract,

polycystic disease, primary glomerular disease,

and postinfectious glomerulonephritis.

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For More Information

American Kidney Fund

6110 Executive Boulevard

Suite 1010

Rockville, MD  20852

Phone:  1–800–638–8299 or 

301–881–3052

Email:  helpline@akfinc.org

Internet:  www.kidneyfund.org

American Society of Pediatric Nephrology

Northwestern University

Feinberg School of Medicine

Pediatrics W140

303 East Chicago Avenue

Chicago, IL  60611–3008

Phone:  312–503–4000

Fax:  312–503–1181

Email:  aspn@northwestern.edu

Internet:  www.aspneph.com

National Kidney Foundation

30 East 33rd Street

New York, NY  10016

Phone:  1–800–622–9010 or 

212–889–2210

Email:  info@kidney.org

Internet:  www.kidney.org

You may also find additional information

about this topic by visiting MedlinePlus

at www.medlineplus.gov.

National Kidney and Urologic

Diseases Information Clearinghouse

3 Information Way

Bethesda, MD 20892–3580

Phone: 1–800–891–5390

Fax: 703–738–4929

Email: nkudic@info.niddk.nih.gov

Internet: www.kidney.niddk.nih.gov

The National Kidney and Urologic Diseases

Information Clearinghouse (NKUDIC) is a

service of the National Institute of Diabetes

and Digestive and Kidney Diseases (NIDDK).

The NIDDK is part of the National Institutes

of Health under the U.S. Department of Health

and Human Services. Established in 1987, the

Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to

their families, health care professionals, and the

public. The NKUDIC answers inquiries, develops and distributes publications, and works

closely with professional and patient organizations and Government agencies to coordinate

resources about kidney and urologic diseases.

Publications produced by the Clearinghouse are

carefully reviewed by both NIDDK scientists

and outside experts. NKUDIC would like to

thank Barbara Fivush, M.D., and Kathy Jabs,

M.D., of the American Society of Pediatric

Nephrology (ASPN), for coordinating the

review of this fact sheet by the ASPN’s Clinical

Affairs Committee: Tej Mattoo, M.D., William

Primack, M.D., Joseph Flynn, M.D., Ira Davis,

M.D., Ann Guillott, M.D., Steve Alexander,

M.D., Deborah Kees­Folts, M.D., Alicia Neu,

M.D., Steve Wassner, M.D., John Brandt, M.D.,

Manju Chandra, M.D. Frederick Kaskel, M.D.,

Ph.D., President, ASPN, and Sharon Andreoli,

M.D., Secretary–Treasurer, ASPN, also provided

comments and coordination.

This publication is not copyrighted. The

Clearinghouse encourages users of this fact

sheet to duplicate and distribute as many

copies as desired.

This fact sheet is also available at

www.kidney.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 06–5167

June 2006