Kidney failure is a serious health problem that can affect newborn children, requiring careful monitoring and prompt treatment to protect the child’s health and ensure the best possible quality of life. In this article on Dalily Medical, we will explain the main causes of kidney failure in children, how to recognize the symptoms early, and the latest treatment methods that help improve their condition. If you are a parent or concerned about your child’s health, this topic is very important, and you need to know all the details to act quickly and correctly.

Should All Newborns Receive Kidney Replacement Therapy?

Usually, long-term peritoneal dialysis can be performed for most newborns with isolated kidney failure. However, the decision to provide this treatment is complex and often controversial between doctors and the child’s family.

When the newborn has complex congenital abnormalities, such as problems with the brain, heart, or lungs, the prognosis may be poor and treatment options limited. In such cases, it may be better to focus on palliative care rather than dialysis.

Therefore, it is very important to discuss each case early with a pediatric nephrology team to decide whether long-term dialysis is the appropriate option.

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Condition and Presentation of Newborns with Kidney Failure

Newborns requiring dialysis usually fall into two main categories:

Acute Kidney Injury (AKI):
This often occurs due to conditions like sepsis or oxygen deprivation around birth. AKI is a common type of kidney failure in newborns and is usually temporary and reversible. Dialysis may be needed only for a short period to support the kidneys until they recover. This decision is made after discussion between the pediatric intensivist and the nephrologist. If the infant has severe brain injury, long-term dialysis might not be suitable.

Chronic Kidney Disease (CKD):
Most often caused by congenital urinary tract abnormalities that obstruct urine flow and significantly affect kidney function. This condition is usually detected before birth via ultrasound or shortly after birth with symptoms of growth delay. CKD can occur alone or alongside other health issues like major heart defects, brain abnormalities, or lung problems. When complex, dialysis outcomes are generally poor, making treatment decisions more difficult.

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Importance of Early Diagnosis and Follow-Up

If kidney problems are detected during pregnancy, it is crucial to involve a pediatric nephrology and urology team early. It is also recommended to have detailed discussions with the family before birth to explain the condition, expected treatments, and to jointly decide the best care approach for the child.

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How Often Does Kidney Failure Occur in Newborns Requiring Dialysis?

A large study conducted between 2000 and 2011 on 264 infants in Europe, Japan, Australia, and New Zealand showed that the number of newborns starting chronic dialysis under one month old is very low.

For example, in New Zealand, only 5 infants started chronic dialysis before 30 days of age between 2004 and 2017. This shows these cases are rare but require specialized care.

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Factors Determining Prognosis in These Infants

• Oliguria (Low urine output): Indicates very poor remaining kidney function and is the most important sign predicting disease progression.

• Associated diseases: Presence of other health problems such as brain injury, heart disease, or congenital anomalies makes treatment more difficult and reduces survival chances.

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Outcomes of Infants Who Survived After Starting Dialysis Within the First Month

An international study tracking 264 infants who began dialysis within their first month of life followed them for an average of about 7 months.

• 219 infants (approximately 83%) survived.

• The 2-year survival rate was about 81%.

• After 5 years, survival decreased to 76%.

Main causes of death among the 45 infants who passed away were:

• 36% due to infections

• 9% due to heart problems

• 16% due to lung problems or pulmonary edema

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Most Common Complications After Chronic Kidney Failure in These Children

• Growth failure in 63%

• High blood pressure in 57%

• Anemia in 55%

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Daily Life for These Children

• Between 60% to 80% can attend school full-time in suitable classes.

• 20% to 40% experience psychological or neurological issues requiring special follow-up and treatment.

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Types of Kidney Failure in Children (Simplified)

1. Acute Kidney Injury (AKI):
   A sudden loss of kidney function occurring over hours or days. Causes include severe infection, dehydration, trauma, or sudden urinary obstruction. Most cases improve with timely treatment.

2. Chronic Kidney Disease (CKD):
   A gradual loss of kidney function over months or years, caused by chronic illnesses such as genetic kidney diseases, persistent infections, or autoimmune diseases. Without proper treatment, CKD can progress to end-stage kidney failure.

3. End-Stage Renal Disease (ESRD):
   The final stage of CKD when kidneys stop functioning entirely. At this point, dialysis or kidney transplant is necessary for survival.

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Causes of Kidney Failure in Children by Age Group

1. Infants (0-1 year):

• Congenital kidney or urinary tract anomalies (e.g., ureteral obstruction, polycystic kidney disease)

• Severe urinary tract or kidney infections

• Urine flow problems due to obstruction or narrowing

• Genetic diseases affecting kidney function from birth

2. Young children (1-5 years):

• Recurrent urinary tract infections causing kidney damage

• Hemolytic uremic syndrome (HUS), a rare condition after certain bacterial infections

• Immune diseases affecting the kidneys

3. Older children (5-10 years):

• Chronic immune diseases like lupus nephritis

• Inflammatory kidney diseases causing gradual loss of function

• Blood flow problems to kidneys due to heart or blood pressure issues

4. Children 10 to 15 years:

• Genetic chronic kidney diseases often emerging in adolescence

• Chronic high blood pressure affecting kidney function

• Autoimmune diseases attacking the kidneys

• Chronic glomerulonephritis

• Early-onset diabetes (Type 1 or 2) affecting kidneys

• Long-term medication use or exposure to toxins

5. Adolescents (over 15 years):

• Worsening chronic diseases like lupus or genetic kidney disorders

• Kidney problems related to substance abuse or harmful drugs

• Metabolic disorders such as high cholesterol or obesity

• Small vessel kidney diseases causing kidney damage

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Symptoms of Kidney Failure in Children by Age Group

1. Infants (0-1 year):

• Swelling of face and eyes, especially in the morning

• Reduced urination or changes in urine color (dark or bloody)

• Fatigue, weakness, poor weight gain

• Persistent vomiting or nausea

• Pale or yellowish skin

• Rapid or difficult breathing due to fluid retention

2. Young children (1-5 years):

• Swelling in hands, feet, or abdomen

• Abnormal urine output (increased or decreased)

• Ongoing fatigue and weakness

• High blood pressure

• Blood or foam in urine

• Abdominal or back pain

• Loss of appetite or weight loss

3. Older children (5-10 years):

• Swelling in limbs or around eyes

• Severe fatigue and constant tiredness

• Changes in urine color or frequency

• High blood pressure

• Persistent headaches or dizziness

• Behavioral changes or difficulty concentrating

• Repeated nausea and vomiting

4. Children 10-15 years:

• Generalized swelling

• Reduced or changed urine output

• Fatigue and weakness

• High blood pressure

• Headaches and dizziness

• Mood changes or concentration difficulties

• Muscle or joint pain

5. Adolescents (over 15 years):

• Swelling of feet, ankles, and hands

• Severe fatigue and unexplained weight loss

• Decreased or changed urine output

• High blood pressure

• Frequent headaches or dizziness

• Fluid retention causing breathing difficulties

• Psychological changes such as depression or anxiety

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How to Manage a Newborn with Acute Kidney Failure Requiring Long-Term Dialysis?

When a newborn has acute kidney failure needing long-term dialysis, some important considerations should be discussed openly with the family:

• Parents’ and relatives’ wishes: Understand their views and clearly explain dialysis options with all available medical information to help them make informed decisions.

• Comprehensive evaluation: Pediatric nephrology specialists must assess if dialysis is truly the best long-term solution.

• Regular review: Families should know that treatment plans will be continuously evaluated, and if the medical team believes dialysis is harming the child or not improving their condition, stopping treatment may be recommended.

• Partnership with family: Dialysis decisions are collaborative between the medical team and family after thorough discussions.

• Difficult decisions: If treatment cessation is necessary, this decision is made jointly, sometimes involving a medical ethics committee.

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Complications of Kidney Failure in Newborns

• Fluid retention and body swelling due to inability to eliminate excess fluid

• High blood pressure caused by electrolyte and fluid imbalances

• Accumulation of toxins leading to poisoning affecting the brain and digestive system

• Electrolyte imbalances like high potassium causing heart rhythm problems

• Anemia due to low erythropoietin hormone production

• Delayed growth and development from poor nutrient absorption

• Breathing difficulties due to lung fluid accumulation or pulmonary hypertension

• Increased infection risk due to weakened immunity

• Acid-base imbalance harming body organs

• Heart and vascular problems from electrolyte disturbances

• Delayed wound healing due to anemia and immune weakness

• Permanent kidney damage if acute failure becomes chronic without treatment

• Delayed mental and motor development from toxin buildup and nutrient deficiencies

• Fluid imbalances causing severe dehydration or fluid overload

• Increased bleeding risk due to clotting factor deficiencies related to kidney failure

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How to Treat Kidney Failure in Children — Easy and Understandable

1. Treatment Based on the Type of Kidney Failure

Acute Kidney Injury (AKI):

• Treat the underlying cause: The first step is to fix the problem that caused the kidney failure, such as a severe infection, dehydration, or urinary tract obstruction.

• Fluid and electrolyte support: The child needs good hydration and balance of salts according to their needs to avoid complications.

• Continuous monitoring: Regular checks of kidney function, urine output, and blood tests are necessary to track improvement.

• Temporary dialysis: In severe cases that require urgent intervention, temporary dialysis may be used to support the kidneys.

Chronic Kidney Disease (CKD):

• Control chronic diseases: Manage underlying illnesses causing kidney damage, like high blood pressure, diabetes, or autoimmune diseases.

• Medications to improve kidney function: Use medicines that reduce blood pressure or protein loss in urine to protect the kidneys from further damage.

• Dietary adjustments: Reduce protein, sodium, and potassium in the child’s diet as recommended by the doctor to reduce kidney workload.

• Regular medical follow-up: The child needs regular checkups to monitor kidney function and overall health.

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2. Nutrition and Growth Support for Children with Kidney Failure

Children with kidney failure often face problems like poor appetite, nausea, and impaired growth because of:

• Fluid and food restrictions

• Effects of medications

• Imbalances in salts and minerals

Therefore:

• Proper nutrition is very important — it’s not just food but part of the treatment.

• Focus on nutrient-rich foods to help the child maintain normal weight and growth.

• Continuous monitoring of growth by tracking weight and height.

How to Support Nutrition:

Goals:

• Maintain normal growth by regularly tracking weight and height.

• Replace missing nutrients like vitamins and minerals due to kidney failure.

• Reduce stress on kidneys by giving an easy-to-process diet.

• Prevent complications such as anemia, weak bones, and weakened immunity.

Diet Components:

1. Calories:
   Provide enough calories for the child’s age and weight to support growth. If appetite is low, use high-calorie liquid supplements. Sometimes, feeding tubes may be needed.

2. Protein:
   In chronic kidney failure, protein intake is slightly reduced to ease kidney work but not too low to harm growth.
   During dialysis, protein needs increase because some is lost during the process.

3. Fluids:
   If the child produces less urine, fluid intake is carefully controlled based on urine output and losses from vomiting or diarrhea.

4. Sodium (Salt):
   Reduce salt intake to prevent fluid retention and high blood pressure. Avoid salty foods like chips, processed meats, and pickles.

5. Potassium:
   If blood potassium is high, limit potassium-rich foods like bananas, potatoes, tomatoes, and oranges. Cooking methods like soaking vegetables before cooking can reduce potassium.

6. Calcium and Phosphate:
   Kidney failure often causes imbalances in calcium and phosphate, affecting bone health. Special medications and supplements like vitamin D are given under strict medical supervision.

Essential Supplements:

• Iron: To treat or prevent anemia common in kidney failure.

• Zinc: Helps improve appetite and supports healthy growth.

• Multivitamins: Especially vitamin D, B12, and folic acid to support bones and immune system and compensate for deficiencies.

Importance of a Pediatric Renal Dietitian:
A nutrition specialist helps set the right amounts of food and fluids based on the child’s weight, age, dialysis type (if any), and lab results, ensuring balanced nutrition tailored to the child’s condition.

When to Use Feeding Tubes:

• If the child cannot eat enough due to poor appetite or fatigue.

• If the child keeps losing weight despite efforts.

• If swallowing is difficult or appetite is severely reduced.

Feeding tubes may be:

• Nasogastric tube (through the nose to the stomach) — usually temporary.

• Gastrostomy tube (directly into the stomach) — for long-term feeding.

These tubes help safely deliver all necessary nutrients.

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3. Medications for Children with Kidney Failure

1. Blood pressure medicines:
   Kidney failure often causes high blood pressure, which worsens kidney damage. Medicines like ACE inhibitors (enalapril, lisinopril) or ARBs help lower blood pressure and protect kidneys. Beta-blockers or diuretics may also be used.

2. Anemia treatment:
   Kidneys produce erythropoietin, a hormone that stimulates red blood cell production. When kidneys fail, erythropoietin decreases, causing anemia.
   Erythropoietin injections stimulate bone marrow, and iron supplements (oral or intravenous) help improve anemia.

3. Electrolyte management:
   Kidney failure disrupts salt and mineral balance.
   Potassium-lowering agents protect the heart if potassium is high. Calcium supplements or phosphate binders help maintain bone health.

4. Treating metabolic acidosis:
   Kidney failure can cause blood acidity to rise. Sodium bicarbonate may be prescribed to balance blood pH.

5. Immunosuppressants:
   For kidney failure due to immune diseases like lupus nephritis, steroids and other immunosuppressive drugs may be needed.

6. Other supportive meds:
   Antibiotics for infections, appetite stimulants, and anti-nausea medicines as needed.

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4. Supportive Care for Kidney Failure in Children

• Monitor fluid intake/output and blood tests regularly for salts, minerals, and other key substances.

• Treat complications like infections or heart problems quickly to keep the child healthy.

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5. Dialysis in Children and Its Types

1. Hemodialysis:

• Blood is passed through a machine that filters waste and excess fluid.

• Blood is taken from and returned to the child through a catheter or surgically created vascular access.

• Each session lasts 3-5 hours, usually done 3 times a week.

• Advantages: Fast and effective waste removal, done in hospital/clinic.

• Disadvantages: Requires vascular access, sessions are long, and can be tiring.

2. Peritoneal Dialysis:

• Uses the lining of the abdomen (peritoneum) as a natural filter.

• A special fluid is put into the belly via a catheter; it absorbs waste and fluid, then drained out.

• Can be done multiple times a day manually or overnight with a machine.

• Advantages: Can be done at home, less tiring especially for young children, more flexible schedule.

• Disadvantages: Risk of infection at catheter site, slower clearance than hemodialysis.

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6. Kidney Transplantation in Children: The Best Solution for End-Stage Kidney Failure

Why transplant?
Kidney transplant offers the best long-term outcome by replacing the failed kidney with a healthy one from a donor, allowing the child to live a near-normal life.

Steps for transplantation:

• Comprehensive evaluation: Full medical checkup including kidney function, heart and lung tests, and infection screening to ensure readiness.

• Finding a suitable donor: Usually a close family member like a parent or relative with matching blood type and tissue to reduce rejection risk.

• Preparing for surgery: Hospital preparation, cleaning the body, and starting medications to prevent organ rejection.

• Surgical procedure: The new kidney is placed in the pelvic area. The old kidneys usually stay unless there’s a medical reason to remove them. Blood vessels and the ureter are connected.

• Post-surgery follow-up: The child stays in hospital for monitoring and must take lifelong immunosuppressive drugs to prevent rejection.

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Daily Diet Plan for a Child with Kidney Failure (0 to 12 Months)

Age	Type of Food and Feeding	Quantity and Notes
0-6 months	Breastfeeding or special kidney formula milk	Feed on demand, about 6-8 times per day
4-6 months	Start introducing light pureed foods	Such as pureed rice or boiled, mashed apple in very small amounts
6-9 months	Increase variety of pureed foods	Boiled pureed vegetables like zucchini and carrots, apple, and pear
9-12 months	Light pureed foods with reduced salt and sodium	Pureed white meats (boiled chicken without salt), allowed fruits and vegetables; avoid high potassium fruits like banana and orange
Throughout	Water intake as per child's needs and doctor’s advice	Avoid excess fluids according to child’s condition

 

Important Tips for Parents:

• Protein: Adjust protein intake with the doctor or nutritionist, as protein is important for growth but excess protein can harm the kidneys.

• Sodium (Salt): Avoid adding salt to the child's food and processed foods high in salt.

• Potassium: Limit fruits and vegetables high in potassium such as bananas, tomatoes, potatoes, and oranges.

• Phosphorus: Minimize dairy products as they increase phosphorus which can damage kidneys.

• Vitamins and Minerals: The child may need vitamin supplements according to the doctor’s prescription; follow up regularly.

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Daily Diet Plan for a Child with Kidney Failure (4-6 Years)

Snack 1	- Plain unsalted biscuits - Natural apple juice diluted with water	❌ Avoid canned juices or high potassium juices like orange juice
Lunch	- 4 tablespoons of white rice or pasta - Grilled skinless chicken breast - Boiled vegetables (zucchini or soaked carrots) - Small traditional bread or white toast	✅ Moderate protein and low potassium vegetables after soaking and cooking
Snack 2	- Two slices of white toast with low-sugar jam - Small amount of natural grape juice	✅ Provides energy without overloading kidneys
Dinner	- Oatmeal cooked with water or special milk - Salt-free cottage cheese - Peeled cucumber