The commonest causes of dialysis in children, leading to end-stage renal disease (ESRD), vary depending on geographic location and population demographics. However, several primary underlying causes are consistently observed in paediatric ESRD (kidney failure, CKD5) cases worldwide.
These common causes include:
1. Birth defects. A birth defect occurs when part of a baby’s body does not develop normally when the baby is in the womb, or uterus. Examples of birth defects that may lead to kidney disease include:
- Renal agenesis – when a baby is born missing one or both kidneys
- Kidney dysplasia – when parts of one or both kidneys don’t develop normally while a baby is developing in the womb
- Renal hypoplasia – when a baby is born with one or both kidneys that are smaller and have fewer nephrons than normal.
2. Other congenital anomalies of the kidney and urinary tract (CAKUT): CAKUT represents a group of congenital conditions affecting the kidneys and urinary tract. Examples include:
- Obstructive nephropathy – for example due due to Posterior Urethral Valves (PUV). This is a condition found in boys that affects the urethra (the tube which runs from the bladder to the outside). In PUV, the urethra has a blockage in it near the bladder. This makes it difficult for a child to pass urine. As the bladder pushes hard to get the urine out, it causes pressure which may result in urine being pushed back from the bladder into the ureters and kidneys.
- Reflux nephropathy: In this condition, abnormal upward flow of urine from the bladder into one or both the ureters occurs, and is called ‘vesicoureteral reflux’. This is a consequence of incompetent and mislocated vesicoureteric valves (see diagram below). Reflux of urine from the bladder backs up into kidneys cause chronic infections.
CAKUT is one of the most common causes of ESRD in children.
3. Cystinosis: This is a rare inherited disorder. The amino acid cystine collects in cells in the kidney called lysosomes.
4. Other hereditary kidney diseases: Genetic conditions such as polycystic kidney disease (PCKD) or Alport’s Syndrome can lead to progressive kidney damage and the need for dialysis.
5. Chronic glomerulonephritis: Glomerulonephritis (GN) refers to a group of autoimmune kidney diseases that affect the glomeruli, the filtering units of the kidneys. Some types of glomerulonephritis occur in children like focal segmental glomerulosclerosis (FSGS; usually presents with nephrotic syndrome, see below). These can progress to ESRD in children.
Nephrotic syndrome
Nephrotic syndrome is characterised by excessive protein loss in the urine, leading to kidney damage over time. Some children with nephrotic syndrome may progress to ESRD. It is usually caused by chronic glomerulonephritis, especially:
- Minimal change disease (MCD) – a disorder in which the glomeruli are damaged, but the damage can only be seen using an electron microscope, which shows tiny details at the cellular level
- Focal segmental glomerulosclerosis (FSGS) – a disease that causes some of the kidney’s glomeruli to become scarred
- Mesangiocapillary glomerulonephritis – a group of disorders that affect the immune system, causing antibodies to build up on a membrane in the kidney, damaging the glomeruli.
Another GN is ‘post-streptococcal’ or ‘post-infectious’ glomerulonephritis, a disease that occurs when the body’s immune system produces antibodies that can deposit in the kidneys and cause damage. This disease may develop after an episode of Strep A throat or a skin infection.
6. Systemic lupus erythematosus (SLE, ‘Lupus’): Lupus is an autoimmune disease that can affect various organs, including the kidneys. Kidney involvement in lupus (‘lupus nephritis’) can lead to ESRD.
7. Haemolytic-uraemic syndrome (HUS): HUS, often in mini-outbreaks caused by E. coli infection, can result in severe kidney damage and the need for dialysis, especially in young children.
8. Acute kidney injury (AKI): Severe and recurrent episodes of AKI, often due to infections, toxic exposures, or other factors, can cause kidney damage that requires dialysis.
9. Trauma: Severe kidney injuries resulting from accidents, falls, or sports-related incidents can damage the kidneys and necessitate dialysis. This usually only affects children born with one kidney.
10. Medication or toxins: Certain medications, toxins, or chemicals can be harmful to the kidneys. Ingesting substances like antifreeze or exposure to heavy metals can lead to kidney damage in children.
While these are some of the common causes of dialysis in children, it’s essential to recognise that each case is unique. The underlying cause of ESRD in a child should be determined by a paediatric nephrologist through comprehensive evaluation and testing.
Last Reviewed on 28 September 2023