Chronic kidney disease
The first step in treating your child is forming an accurate and complete diagnosis. It’s important to remember that diagnosis for chronic kidney disease can be thought of in two ways: diagnostic tests that indicate a problem with your child’s kidneys, and kidney function tests that tell us how well they are working.
Since children with chronic kidney disease rarely show symptoms in the beginning, it often goes undiagnosed until its later stages. Your child’s pediatrician should be monitoring for it during regular check-ups by:
- performing routine urinalyses and looking for protein in your child’s urine (called “proteinuria”)
- checking your child’s blood pressure
The diagnostic process often begins when your child’s pediatrician notices protein in your child’s urine during a routine urinalysis, a sign (though not a conclusive one) of kidney disease.
If your child has the signs associated with nephrotic syndrome (NS), her doctor will most likely start her on steroid treatment. The majority (80 to 90 percent) of children respond to steroid treatment, and within eight to 12 weeks, the symptoms disappear. This is known as “minimal change nephrotic syndrome,” and it can come and go, like asthma. Many children outgrow minimal change nephrotic syndrome after a few years.
NS that doesn’t respond to steroid treatment is thought to have a different cause. If your child’s NS doesn’t respond to steroid treatment, her doctors may order further diagnostic tests including:
kidney biopsy - a small sample of tissue is taken from through a needle and sent to a lab for analysis. The biopsy may indicate focal segmental glomerulosclerosis (FSGS) or the presence of another acquired disease, such as lupus.
kidney ultrasound - a non-invasive test in which a transducer is passed over the kidney producing a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst or other obstruction or abnormalities.
- nuclear medicine study – a non-invasive, painless tests that can reveal important information about your child's health. Nuclear medicine uses short-lived radiopharmaceuticals and specialized cameras to create images of the human body.
Kidney function tests
There are two main ways to test your child’s kidney functioning: by measuring her creatinine level and glomerular filtration rate (GFR).
Creatinine is a waste product that the body makes in a constant amount (depending on muscle mass) each day. It can only leave the body through the kidneys, so a higher creatinine level indicates decreased kidney functioning. Creatinine level is checked through a simple blood test.
GFR (glomerular filtration rate) is a measure of how efficiently your kidneys are able to filter your blood.
Other blood tests may be used to check cholesterol level, and for the level of a blood protein called albumin.
How your child feels
In addition to the results of these tests, we also look at your child’s symptoms and how she feels. Despite having a high creatinine level, if she’s feeling well and going to school, it’s probably not time for her to go on dialysis or have a kidney transplant.
After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we’ll meet with you and your family to discuss the results and outline the best treatment options.
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