What Does Growing Up With Pediatric Chronic Kidney Disease Involve? Nutrition, School and Play

The pizza arrives at the birthday party and one parent in the room does quiet math. Two slices or one? Pepperoni or cheese? Is the juice on the table the kind with added phosphate? Nobody else notices. Her seven-year-old is already at the bouncy castle, shoes off, shrieking with everyone else.

That split-screen is the reality of living with CKD, child by child and family by family: an ordinary childhood running alongside a chronic condition that asks for planning most people never see. The kidneys do far more than make urine, so when they work below par, the effects show up in appetite, height, energy, blood pressure and bone strength.

This explainer walks through what pediatric chronic kidney disease involves day to day, from the first clinic appointments to lunchboxes, gym class and the questions worth asking the care team. The evidence is clearer than the myths, and the decisions always belong to the child, the family and the treating team.

What does living with CKD actually mean for a child?

Kidneys are two filtration plants roughly the size of a child’s fist. Every day they clean the blood, balance water and salts, and dispose of waste as urine. They also do quieter jobs: releasing a hormone called erythropoietin that tells bone marrow to make red blood cells, converting vitamin D into its active form so bones can absorb calcium, and helping regulate blood pressure.

Chronic kidney disease, or CKD, means the kidneys have been damaged or working below normal for at least three months, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The word chronic signals that the change is long-standing rather than a passing illness, not that it is necessarily severe.

Doctors describe how well the kidneys filter using the estimated glomerular filtration rate, or eGFR: a number calculated from a blood test and the child’s height that estimates how much blood the filters clean each minute. In children, teams use child-specific equations, and normal values in infants are lower than in older kids, so the number is always read alongside age.

Why does CKD play out differently in childhood? A growing body is building bone, brain and muscle at the same time it is coping with waste that lingers in the blood. Appetite often drops. Acid can accumulate. Red blood cell production can slow. Each of those has a direct effect on height, energy and concentration. Pediatric kidney care is therefore less about a single organ and more about protecting growth and development while preserving whatever kidney function remains.

Held in balance, those two goals define what living with CKD as a child looks like: medical attention on a schedule, and a childhood that carries on in between.

Why kidney disease in children usually starts differently than in adults

Ask an adult nephrologist what damages kidneys and the answer is usually diabetes and high blood pressure. Ask a pediatric nephrologist and the list looks completely different.

According to NIDDK, the most common causes of kidney disease in children are problems present from birth. The medical shorthand is congenital anomalies of the kidney and urinary tract: a kidney that did not form fully, a blockage where urine leaves the kidney, or a valve problem that lets urine flow backward toward the kidneys, known as vesicoureteral reflux. Many of these are spotted on a prenatal ultrasound before the baby is born.

Inherited conditions form the second group. Polycystic kidney disease, in which fluid-filled cysts gradually crowd out working tissue, is one example. A third group involves the glomeruli, the microscopic filtering units. Inflammation there, called glomerulonephritis, or heavy protein leakage, called nephrotic syndrome, can scar the filters over time. Less often, a serious infection, a severe episode of low blood flow, or certain medicines cause acute injury that does not fully recover.

This matters for families in two ways. First, guilt. Parents often search their memory for something they fed or failed to do. In most childhood cases the answer is nothing; the cause was written into how the kidneys formed. Second, trajectory. A structural problem found in infancy may progress slowly over many years, while an aggressive glomerular disease may move faster and require more intensive treatment early. The pediatric team’s job in the first months is often to identify which story the child is in.

Not every child with a kidney difference has CKD. Some structural variations never affect function and simply need periodic checks, which is one reason clinics monitor before they treat.

Pediatric CKD stages: who is watched, who is treated and who is asked to wait

Kidney disease is graded in five stages by eGFR. Mayo Clinic lists the standard cutoffs: stage 1 at 90 or above with evidence of damage, stage 2 between 60 and 89, stage 3 between 30 and 59, stage 4 between 15 and 29, and stage 5 below 15, when the kidneys can no longer sustain the body without dialysis or a transplant. The urine protein level and blood pressure sit alongside the stage in every clinic letter, because protein leaking through the filters is one of the clearest signals of ongoing damage.

Stage	eGFR (mL/min/1.73 m²)	What care usually focuses on in a child
1	90 or higher	Confirming the cause, blood pressure checks, urine protein monitoring
2	60 to 89	Growth tracking, treating the underlying condition, protecting remaining function
3	30 to 59	Watching for anemia, bone and mineral changes, acid balance; dietitian involvement
4	15 to 29	Planning ahead for kidney replacement options; more frequent visits
5	Below 15	Dialysis or transplant, with continued growth and nutrition support

Who is treated actively and who is watched? A child in stage 1 or 2 with normal blood pressure and little urine protein is usually monitored, sometimes for years, because there is no evidence that aggressive intervention helps when the filters are coping. A child with stage 3 or beyond typically needs medicines for blood pressure, acid balance, bone health or anemia, and the dietitian becomes a regular presence.

Who is asked to wait? Families often ask about transplant early. Programs generally list children only once function has fallen far enough that replacement is clearly needed, because a transplant brings its own lifelong medicines and risks. The staging framework is a guide, not a countdown; two children at the same stage can have very different years ahead depending on cause, blood pressure and growth.

What the first weeks after a diagnosis usually look like

The diagnosis often arrives sideways: a routine urine dipstick at a check-up, a scan done for something else, or a baby whose prenatal ultrasound flagged a kidney. What follows is a burst of appointments that can feel overwhelming and then settles into a rhythm.

Expect blood tests to measure creatinine and electrolytes, a urine test for protein, and an ultrasound to look at kidney size and structure. Blood pressure is measured with a cuff sized to the child’s arm, because an adult cuff on a small arm gives falsely low readings. Some children need a kidney biopsy, in which a needle removes a tiny piece of tissue for examination under a microscope; this is usually done under sedation or anesthesia and is reserved for cases where the cause is unclear.

Within the same weeks, most families meet the wider team: a pediatric nephrologist who leads care, a renal dietitian, a nurse specialist, and often a social worker or psychologist. Larger programs add a child life specialist who helps children understand procedures through play.

Visit frequency depends on stage. NIDDK describes early-stage care as regular monitoring with periodic blood and urine tests, while advanced stages need closer follow-up. The team will tell you the interval for your child; it may lengthen if results are stable.

Three habits pay off early. Keep a simple folder or phone note with the child’s key numbers and medicine list. Learn what eGFR and urine protein mean so clinic conversations feel like a discussion rather than a lecture. Tell the school something, even if only the basics, so bathroom access and water bottles stop being a daily negotiation.

Above all, notice what has not changed. A child who ran to the car before the diagnosis will run to the car after it.

Why the team watches height, hemoglobin and bones so closely

Growth is the pediatric kidney clinic’s most revealing measurement. A child who is gaining height along a steady curve is, in a real sense, telling the team that nutrition, acid balance and hormones are holding. A child who drifts downward across percentiles prompts a search for why.

NIDDK identifies several reasons children with CKD grow more slowly than peers. Appetite falls as waste products accumulate, so calories fall short. Acid builds up in the blood because the kidneys excrete less of it; this metabolic acidosis directly interferes with bone growth and muscle. The body’s response to growth hormone is blunted even when the hormone itself is present.

Bones face a second challenge, often called CKD mineral and bone disorder. Failing kidneys struggle to remove phosphorus and to activate vitamin D. Phosphorus rises, calcium falls, and the parathyroid glands respond by releasing more parathyroid hormone, which pulls calcium from bone. Over years this can weaken bones and, in children, affect the growth plates themselves.

Anemia rounds out the trio. With less erythropoietin, the marrow produces fewer red blood cells; iron stores are often low as well. The result is fatigue, poor concentration and reduced exercise tolerance that families sometimes mistake for laziness or mood.

Each problem has an approach. Acid can be neutralized with prescribed alkali. Phosphorus can be managed through diet and, when needed, medicines that bind it in the gut. Active vitamin D can be replaced. Anemia is treated with iron and, if required, injections of an erythropoiesis-stimulating agent, a laboratory version of the missing hormone. When growth remains poor despite all this, teams may discuss growth hormone therapy. Whether, when and how any of these are used is the nephrologist’s call, based on blood results that are often rechecked every few months.

CKD diet for kids: what a renal dietitian actually changes

The single biggest misunderstanding about a CKD diet for kids is that it is a fixed list of banned foods copied from adult pamphlets. In children the order of priorities is reversed: enough energy to grow comes first, and restrictions are added only when blood results demand them.

Calories lead. A renal dietitian works out how much energy the child needs for age and size, then finds ways to reach it when appetite is poor, sometimes with calorie-dense additions to ordinary meals. Infants with CKD frequently need feeding support through a nasogastric or gastrostomy tube, according to NIDDK, because babies cannot take enough by mouth to grow when they feel unwell. This is a growth tool, not a failure of parenting.

Protein is adjusted, not eliminated. Children need protein to build tissue, so the dietitian aims for an amount that supports growth without overloading the kidneys with waste. Severe protein restriction, once common in adult practice, is not the model for children.

Sodium is the restriction that helps most children most often. Less salt lowers blood pressure and reduces fluid retention. Since most salt in a typical diet comes from processed foods rather than the shaker, the practical work is in reading labels and cooking simply.

Potassium and phosphorus are managed only when blood levels rise. Phosphorus hides in additives; an ingredient list with the letters p-h-o-s in it usually signals added phosphate, which the body absorbs more readily than the natural phosphorus in foods like beans.

Fluids surprise families. Some children with structural kidney problems pass large volumes of dilute urine and need more fluid than their peers to avoid dehydration, while children on dialysis may need limits. The dietitian sets the target, and it changes over time.

Lunchboxes, parties and picky eaters: the everyday food view

Principles are one thing; a Tuesday morning lunchbox is another. Families who manage well tend to build a small repertoire of meals the child likes that fit the current plan, then rotate them, rather than reinventing every day.

Parties and holidays deserve advance thought, not avoidance. Many dietitians suggest asking about the menu, eating a small suitable meal beforehand so the child is not ravenous, and choosing the one or two treats that matter most. A child who is never allowed anything at a party learns to resent the diet; a child who chooses knowingly learns to manage it.

Picky eating is common in CKD because nausea and altered taste make foods unappealing. Pressure rarely helps. Offering small portions frequently, keeping mealtimes short and calm, and letting the child have some control over choices within the plan are approaches dietitians commonly recommend. If weight or height stalls, the team may change the plan rather than blame the table.

Supplements need a conversation first. Herbal products, protein powders and sports drinks can contain potassium, phosphorus or compounds the kidneys must clear. The NIH Office of Dietary Supplements notes that people with kidney disease should check with their health care provider before using supplements, and that applies with extra force to children. So-called kidney cleanses have no evidence of benefit and can be harmful.

Eating out is possible. Grilled rather than breaded, sauces on the side, plain rice or potato, and water instead of dark sodas cover most menus without drawing attention.

Finally, watch the child, not just the numbers. A plan that produces stable blood results but constant tears is not working; the team can usually find a middle ground, and asking for one is part of good care.

Children with kidney disease at school: what actually helps

School is where a child with CKD spends the largest share of waking hours, and where the condition is least visible. Teachers cannot accommodate what they do not know, so most pediatric kidney teams encourage families to share a brief written summary with the school at the start of each year.

The practical supports are modest and specific. Unrestricted bathroom access matters because some children with kidney problems pass urine frequently, and asking permission in front of classmates is a daily humiliation. A water bottle at the desk matters when the fluid target is high. Permission to eat a snack in class helps children whose appetite comes in small windows or who need food with certain medicines. The school nurse may hold prescribed medicines and a copy of the care plan.

In the United States, these accommodations are commonly formalized through a Section 504 plan, which sets out adjustments for a student with a medical condition, or an individualized education program when learning needs are involved. Similar frameworks exist elsewhere. Written plans survive staff changes; verbal arrangements often do not.

Fatigue and concentration deserve honest discussion. Anemia and high waste levels can make afternoons hard; a child may look fine and still be struggling to follow a lesson. Teachers who understand this respond differently to a slumped head.

Absences are inevitable around clinic visits, and much more frequent for children on in-center dialysis, who may miss part of several days each week. Many dialysis units offer hospital-based schooling or liaise with the home school so work continues.

Children with kidney disease at school also field questions from peers. Rehearsing a short, matter-of-fact answer with the child gives them control of their own story.

Living with CKD as a child: is play and sport safe?

The instinct to wrap a child in cotton wool is understandable and, according to the evidence, usually unhelpful. Physical activity supports blood pressure control, bone strength, mood and sleep in children with CKD just as it does in others, and pediatric kidney teams generally encourage it.

A few situations call for a conversation rather than a blanket rule. Children with a single functioning kidney often ask about contact sports. Kidney injuries in sport are rare, and most pediatric guidance frames the decision as an individual one based on the sport, the child’s anatomy and the family’s values. Protective equipment may be discussed. Ask the nephrologist directly rather than assuming a ban.

Dialysis changes the calculation. A child with a peritoneal dialysis catheter in the abdomen is usually advised to avoid swimming in lakes, rivers or public pools because of infection risk, and to protect the catheter during play. A child with a tunneled catheter for hemodialysis has similar restrictions on water and on activities that could pull at the line. A child with an arteriovenous fistula in the arm, a surgically created connection between an artery and a vein used for dialysis access, is typically told to avoid heavy pressure on that arm.

After a transplant, the new kidney sits lower in the abdomen than a native kidney and is less protected by the ribs. Teams usually advise waiting until healing is complete before contact activities, then discuss which sports are reasonable.

Heat and hydration deserve attention for everyone. Children whose kidneys cannot concentrate urine well lose fluid quickly on hot days, while children on fluid limits cannot simply drink more. The team can set sensible guidance for practices and game days.

Play is not a reward for good blood results. It is part of the treatment.

Blood pressure, medicines and clinic visits: what to expect

If one number predicts how fast kidney disease progresses, it is blood pressure. High pressure damages the filters, and damaged filters raise pressure, a loop that pediatric teams work hard to interrupt. Expect blood pressure at every visit, sometimes a 24-hour wearable monitor at home, and a home cuff with a child-sized sleeve if readings run high.

Several medicine classes appear repeatedly in pediatric CKD, and it helps to understand what each is for even though the prescribing decisions rest entirely with the nephrologist. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers lower blood pressure and also reduce the pressure inside the glomeruli, which cuts protein leakage; they are commonly the first choice when urine protein is high. Alkali medicines neutralize the acid that builds up as filtration falls. Phosphate binders are taken with meals and attach to phosphorus in the gut so less is absorbed. Active vitamin D compounds support calcium balance. Iron and erythropoiesis-stimulating agents address anemia.

Timelines are gradual. Blood pressure medicines usually show their effect over days to weeks, and the team adjusts based on repeat measurements rather than a single reading. Anemia treatment is judged by blood counts rechecked over weeks. Nothing here should be started, stopped or changed at home; abruptly stopping a blood pressure medicine can cause a rebound rise.

Two safety habits are worth building. First, ask the pharmacist and the kidney team before any new medicine, including over-the-counter products. Certain common pain relievers in the nonsteroidal anti-inflammatory class can reduce kidney blood flow and are often avoided in CKD. Second, agree a sick-day plan in advance: when a child is vomiting or has diarrhea, the team may want to be called before the usual medicines are given, because dehydration changes how the kidneys handle them.

When kidneys fail: dialysis and transplant explained for families

Most children with CKD never reach kidney failure during childhood, but every family wants to understand what would happen if function fell far enough. Knowing the options early removes some of the fear.

Dialysis replaces the filtering job of the kidneys. Hemodialysis passes blood through a machine that cleans it, usually several times a week in a center, though home options exist in some programs. Peritoneal dialysis uses the lining of the abdomen as a natural filter: a soft catheter carries a cleaning fluid into the abdomen, waste passes into it, and the fluid is drained, typically overnight at home with a cycler machine. NIDDK notes that peritoneal dialysis is often used for children because it can be done at home and allows school attendance during the day. Neither form replaces the kidneys’ hormone functions, so anemia and bone care continue.

A kidney transplant places a donated kidney, from a living donor or a deceased donor, into the lower abdomen and connects it to the child’s blood vessels and bladder. The child’s own kidneys are usually left in place unless there is a specific reason to remove them. NIDDK describes transplant as the preferred treatment for many children with kidney failure when a suitable kidney is available, because it restores the widest range of kidney functions and supports growth. Some children receive a transplant before ever starting dialysis; others wait on dialysis for a suitable match.

A transplant is not the end of kidney care. Lifelong immunosuppressant medicines, which dampen the immune system so it does not reject the new organ, bring their own monitoring for infection and side effects, and clinic visits continue.

Which path, and when, is a shared decision among the child, the family and the transplant and dialysis teams, weighing the child’s size, cause of disease, donor availability and readiness.

Siblings, independence and the teenage handover

A chronic condition in one child reshapes the whole household. Siblings notice the extra appointments, the different snacks, the attention. Some become fiercely protective; others quietly resent it. Pediatric teams often suggest giving siblings their own small role, such as helping pack the clinic bag, and their own protected time with a parent.

Independence is a skill to be built deliberately. A young child can learn the names of their medicines. An older child can read a food label for sodium. A pre-teen can keep their own blood pressure log. Each step transfers a little ownership, so that by adolescence the young person understands their own condition rather than having it managed around them.

Adolescence is the hardest stretch in many pediatric CKD stories. Teenagers want to be like their friends, and daily medicines, fluid limits and clinic visits mark them out. Missed medicines are common in this age group across chronic conditions, and in transplant recipients the consequences can be severe. Teams increasingly ask teenagers to attend part of each visit alone, so that honest conversations about adherence, alcohol, sexual health and mood can happen without a parent in the room.

Mental health belongs in the care plan. Anxiety and low mood are more frequent in children with chronic illness, and fatigue from anemia can look like depression or hide it. Ask whether the clinic has a psychologist or social worker; many do.

Eventually comes the handover to adult services, usually in the late teens or early twenties depending on the health system. A planned transition, with overlapping visits and a written summary the young person understands, works better than an abrupt transfer. Parents describe this stage as letting go of the folder they have carried for years, and it is a milestone worth marking.

What people often get wrong about a child with CKD

Some beliefs about kidney disease travel from adult experience or the internet and land badly on children. Correcting them saves real harm.

The first is that every child with CKD needs a low-protein diet. In children, protein restriction can stunt growth; dietitians aim for an adjusted amount that supports development, and the target varies with stage and blood results. Copying an adult renal diet onto a child is a common and avoidable mistake.

The second is that drinking large amounts of water flushes or heals the kidneys. Water does not repair damaged filters. Fluid needs in CKD vary enormously: some children need more than usual, some need limits, and the right amount comes from the team, not a general wellness rule.

The third is that childhood kidney disease is caused by sugar, salt or junk food. Kidney disease in children is most often congenital or inherited, as NIDDK describes. Diet matters for managing the condition, not for having caused it.

The fourth is that a diagnosis means dialysis is imminent. Many children remain in early stages for years with monitoring alone; the stage table above is a map, not a schedule.

The fifth is that the child must avoid exertion. Activity is encouraged for most children with CKD, with specific precautions for dialysis access and recent surgery.

The sixth is that herbal remedies or kidney cleanses are harmless because they are natural. Several plant products contain compounds the kidneys must clear or that raise potassium, and none has evidence of benefit in CKD.

The seventh is that a transplant ends the condition. It changes it. Immunosuppression, monitoring and lifestyle care continue for life, and the child remains under kidney follow-up.

Questions to ask your care team

Clinic visits pass quickly, and the questions that matter most tend to surface in the parking lot afterward. Writing them down beforehand changes the conversation. These are the ones families and pediatric kidney nurses most often wish had been asked earlier.

• What is my child’s cause of kidney disease, and does it tell you anything about how things may change over time?
• What stage is my child in now, and which numbers are you watching most closely: eGFR, urine protein, blood pressure or growth?
• How often will we come to clinic, and what would make you want to see us sooner?
• Which foods and fluids need attention right now, and which restrictions can we relax?
• Is there anything about my child’s growth, blood count or bone results that you are treating or considering treating?
• What is each medicine for, how will we know it is working, and what should we do if a dose is vomited or missed?
• Are there over-the-counter medicines, supplements or sports drinks we should avoid?
• What is our sick-day plan for vomiting, diarrhea or fever?
• Which sports and activities are fine, and are there any that need a specific conversation?
• What should the school know, and can you provide a letter or care plan we can share?
• Who do we call outside clinic hours, and what counts as an emergency?
• If kidney function falls further in future, what options would we be discussing, and roughly when would that conversation begin?
• Is there psychological, social work or peer support available for my child and for siblings?
• How and when will we start preparing my child to take over parts of their own care?

No team will mind a list. Most will welcome it, because a family that understands the plan is a family that can follow it.

When to call your doctor

Most days with pediatric CKD are ordinary. The skill families develop is recognizing the uncommon day quickly, because children can deteriorate faster than adults and their kidneys have less reserve to absorb a shock. The kidney team will give specific thresholds for your child; the signs below are the general red flags that pediatric kidney services and Mayo Clinic describe.

Call the kidney team the same day, or the emergency service if the child looks unwell, for any of the following:

• Swelling of the face, eyelids, legs or abdomen, or sudden weight gain over a day or two, which can signal fluid retention.
• Breathlessness, especially lying flat, or a new persistent cough.
• Passing much less urine than usual, or no urine for many hours in a child who normally passes it freely.
• Vomiting or diarrhea that stops the child keeping down fluids or medicines, because dehydration can tip kidney function sharply.
• Severe headache, blurred vision, confusion, unusual drowsiness or a seizure, which can indicate dangerously high blood pressure.
• Visible blood in the urine, or urine that is dark brown or cola-colored.
• Muscle weakness, a racing or irregular heartbeat, or tingling, which can accompany a high potassium level.
• Fever in any child with a dialysis catheter, a fistula, or a transplant, or redness, pain or discharge at a catheter site.
• A child who is simply not themselves: unusually listless, refusing food and drink, or hard to rouse.

In an emergency, call your local emergency number rather than waiting for the clinic to open. Keep the child’s medicine list and the kidney team’s contact details somewhere every caregiver, including grandparents and babysitters, can find them.

It is never wrong to call about something that turns out to be minor. Pediatric kidney teams would rather hear from you ten times about nothing than miss the one time it was something.

Frequently asked questions

What is kidney disease in children most often caused by?

Most childhood kidney disease comes from problems present at birth, such as kidneys that did not form fully, blockages in the urinary tract or urine flowing backward toward the kidneys. Inherited conditions like polycystic kidney disease and inflammatory diseases of the kidney filters are the next most common groups. Unlike adults, diabetes and high blood pressure are rarely the cause in children, so parents did not bring it on through diet.

What are the pediatric CKD stages and what do they mean?

Pediatric CKD is graded in five stages by estimated glomerular filtration rate: stage 1 at 90 or above with kidney damage, stage 2 from 60 to 89, stage 3 from 30 to 59, stage 4 from 15 to 29, and stage 5 below 15. Early stages usually mean monitoring; later stages bring medicines for blood pressure, anemia and bones; stage 5 requires dialysis or transplant. The team also weighs urine protein and growth.

Does a CKD diet for kids mean cutting out protein?

No. Children need protein to grow, so renal dietitians adjust the amount to the child’s stage and blood results rather than restricting it heavily. The first priority is enough calories for growth. Sodium is the most common restriction because it helps blood pressure, while potassium and phosphorus limits are added only if blood levels rise. Copying an adult renal diet onto a child can stunt growth.

How do children with kidney disease at school get the support they need?

A short written summary shared with the school at the start of each year is the usual starting point. Common supports include unrestricted bathroom access, a water bottle at the desk, permission to snack, medicines held by the nurse and flexibility around clinic absences. In the United States these are often formalized in a Section 504 plan. Teachers who understand fatigue from anemia respond very differently to a tired child.

Can a child with CKD play sports?

In most cases yes, and teams generally encourage activity for blood pressure, bone and mental health. Specific precautions apply to children with dialysis catheters, who are usually told to avoid swimming and protect the line, to fistula arms, and to the months after a transplant. Children with a single kidney should discuss contact sports individually with their nephrologist rather than assuming a ban.

Why is my child's height measured at every kidney appointment?

Height is one of the most sensitive signs of how well a child with CKD is doing overall. Slowing growth can reveal acid buildup, insufficient calories, anemia or mineral and bone imbalance before blood tests fully show them. When growth lags despite nutrition and correction of these problems, the team may discuss growth hormone therapy, a decision that belongs to the nephrologist.

How much water should a child with kidney disease drink?

There is no universal amount. Some children with structural kidney problems pass large volumes of dilute urine and need more fluid than their peers to avoid dehydration, while children on dialysis may need strict limits. Drinking extra water does not repair damaged kidneys. The renal dietitian and nephrologist set a fluid target for the individual child and revise it as function and treatment change.

Are herbal supplements or kidney cleanses safe for a child with CKD?

They are not recommended. Many herbal products contain potassium, phosphorus or compounds that damaged kidneys cannot clear well, and kidney cleanses have no evidence of benefit. The NIH Office of Dietary Supplements advises people with kidney disease to check with their health care provider before taking any supplement, and that caution is stronger for children. Ask the kidney team before giving any product, including sports drinks.

What happens if a child's kidneys eventually fail?

The options are dialysis or a kidney transplant. Peritoneal dialysis, done at home overnight through an abdominal catheter, is often used for children because it allows normal school attendance; hemodialysis cleans the blood through a machine, usually in a center. A transplant restores the widest range of kidney functions but requires lifelong immunosuppressant medicines and follow-up. The choice and timing are made with the child’s team.

Which signs mean I should call the kidney team urgently?

Call the same day, or emergency services if the child looks unwell, for swelling of the face or legs, breathlessness, much less urine than usual, vomiting that prevents fluids or medicines, severe headache or confusion, blood in the urine, muscle weakness or an irregular heartbeat, fever with a dialysis catheter or transplant, or a child who is unusually drowsy. Your team will give thresholds specific to your child.

References

• Kidney Disease in Children – NIDDK, National Institutes of Health
• Chronic kidney disease – NHS
• Chronic Kidney Disease – Cleveland Clinic
• Chronic kidney disease – MedlinePlus Medical Encyclopedia

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.