Children's Hospital Colorado

Kidney Failure in Children

What is pediatric kidney failure?

Kidney failure is a decrease in the function of the kidneys — two bean-shaped organs that remove waste and water from the blood to make urine (pee). They are part of the urinary tract. The urinary tract also includes the bladder (which holds urine), ureters (the tubes that carry urine from each kidney to the bladder) and urethra (where urine comes out). Kidney failure is also called renal failure.

There are two types of kidney failure. The first is acute kidney failure, or AKI for acute kidney injury. This is a sudden and temporary problem in kidneys that are otherwise healthy. In AKI, the kidneys often recover at least to some extent or even heal.

The second type of kidney failure is chronic kidney failure, which is called chronic kidney disease (CKD). This is when children or adults have or develop a kidney condition that doesn't go away. These conditions can range from mild to very serious. There are treatments available for every stage of CKD.

What causes kidney failure in children?

Acute kidney injury (AKI) in children can be caused by dehydration, by certain medicines or health conditions, and by other things. There are three categories of AKI:

  • Prerenal AKI occurs in the circulatory system, before the blood reaches the kidneys. It is usually caused by dehydration, blood loss or heart trouble that deprives the kidneys of getting enough oxygen.
  • Intrinsic AKI is a problem within the kidneys. It is usually caused by certain medicines, injuries or health conditions that damage the kidneys.
  • Postrenal AKI is a problem in the urinary tract below the kidneys. It happens when a blockage in the lower urinary tract causes urine to back up, generating backpressure on the kidneys that results in impaired kidney function.

Chronic kidney failure (also known as chronic kidney disease, or CKD) in children is most often caused by a problem in the development of the kidneys or urinary tract. It can also result from damage to the kidneys.

Who gets pediatric kidney failure?

Kidney failure can happen to anyone, including children and teens of all ages and ethnicities. It is not genetic, though some genetic conditions can cause it.

Because kidney failure is rare, there are few pediatric nephrologists — doctors who specialize in kidney failure in children and teens. At Children's Hospital Colorado, our team of pediatric nephrologists is nationally recognized for our care by U.S. News & World Report and 5280 magazine's Top Docs. We are also at the forefront of research and teaching to improve kidney failure outcomes. Our specially-trained and experienced team is here for your family.

What are the signs of kidney failure in children?

Sometimes there are no signs of kidney failure. When kidney failure is mild, it often goes undetected unless doctors do testing for another reason. Signs also depend on the cause of the kidney failure.

Typical signs of kidney failure can include:

  • Decreased urine output
  • Fluid retention, leading to body swelling
  • Decreased energy
  • Paleness caused by anemia (a low level of red blood cells)

Additional, non-specific symptoms can include:

  • Poor appetite
  • Vomiting
  • Headaches
  • Stunted growth
  • Urinary tract infections
  • Incontinence (inability to hold urine)
  • Fever
  • Rash
  • Bloody diarrhea
  • Abdominal mass (a noticeable lump in the abdomen)

What tests do we use to diagnose kidney failure in children?

After discussing your child’s medical history and doing a physical exam, additional tests may include:

  • Blood work to test kidney function
  • Urine testing to check protein levels
  • Imaging (usually ultrasound) to look at the kidneys and urinary tract, and detect any blockages, masses or abnormalities
  • A kidney biopsy, if we need a small sample of kidney tissue to diagnose a problem or check its condition

What to expect from a kidney biopsy

A kidney biopsy is when we take a small sample of kidney tissue to look at under a microscope. We can do this on an outpatient basis, meaning your child does not need to stay in the hospital overnight.

Your child should have an empty stomach before this procedure. We will place an IV, which is a thin tube that delivers medicine, directly into a vein. We will also provide sedation (light sleep) or full anesthesia (complete unconsciousness). This decreases stress and pain as much as possible.

We insert a needle through your child's back onto the surface of the kidney and watch our movements using ultrasound. We then remove a few small pieces of kidney tissue (about half an inch in length and between a hair and a spaghetti noodle in thickness). We then process and stain the tissue to enhance its appearance under a microscope, and study it, which takes a few days.

The kidney biopsy usually lasts about 60 minutes. Your child will then wake up from the anesthesia, and we will monitor them for several hours to watch for any bleeding or other problems. When your child goes home, they will need to avoid strenuous activities for several days. We will instruct parents to call about any concerns or changes.

When we have the biopsy results a few days after the procedure, we will discuss them with your family and develop a personalized treatment plan together.

How do we diagnose kidney failure in children?

We diagnose kidney failure by considering your child's symptoms and test results. Blood and urine tests are most common, followed by imaging and then biopsy.

How is kidney failure treated in children?

Treatment depends on the cause of the kidney failure, on whether it is acute or chronic, and – most importantly – on how severe it is. It also depends on your child's tolerance for certain therapies, and your preferences as a family.

Treatments may include monitoring, medicines and diet changes. When a child's kidney failure is severe, treatment may include dialysis, in which we use a machine to filter waste and water from their blood.

As a final measure, some children with the most severe, chronic kidney failure will need a kidney transplant. This is when we replace one of their kidneys with a healthy kidney donated by another person, living or deceased. One good kidney is enough to keep a person reasonably healthy.

What's life like after a kidney transplant?

Once these patients recover from their transplant surgery, we expect kids who get kidney transplants to live full, normal lives.

They will need to take medicine for the rest of their lives to make sure their body's immune system doesn't fight their new kidney, and they will need regular follow up with laboratory testing.

Why choose Children's Colorado for kidney failure treatment?

Our pediatric kidney care team has vast experience in caring for children with kidney disorders. We are a multidisciplinary group of doctors, nurses, dietitians, social workers and other pediatric professionals providing child-centered care. We also have the only pediatric dialysis and Kidney Transplant Program in the region. This makes us the optimal choice for comprehensive kidney care in children.

In addition, we work closely with our Fetal Care Center, where we can sometimes detect kidney issues even before birth. We also collaborate with other specialties like our Department of Pediatric Urology, where we manage conditions together that involve the kidneys and the lower urinary tract. A common example for such conditions is congenital anomalies of the kidneys and the urinary tract (CAKUT).