Causes of CKD in children
Very different from adult CKD:
- Congenital Abnormalities of Kidney and Urinary Tract (CAKUT, ~50%): dysplasia, hypoplasia, obstruction, reflux.
- Inherited disorders (~15%): Alport syndrome, cystinosis, polycystic kidney disease, nephronophthisis.
- Glomerular disease (~10%): FSGS, IgA nephropathy, lupus nephritis, MCD.
- Reflux nephropathy (~10%).
- Acquired/other (~15%): HUS, vasculitis, drug-induced.
Many children are diagnosed antenatally (on the 20-week scan) or as infants. Early diagnosis allows protective care from birth.
Growth and nutrition
Children with CKD often grow poorly because of:
- Reduced appetite
- Acidosis (blocks growth)
- Bone disease (low calcium, raised phosphate, low vitamin D)
- Anaemia
- Resistance to growth hormone
Management (under paediatric renal dietitian):
- High-calorie diet, sometimes overnight tube feeds
- Bicarbonate supplementation for acidosis
- Phosphate binders if needed
- Active vitamin D (alfacalcidol)
- Erythropoietin for anaemia
- Recombinant human growth hormone (rhGH) injections from age 2 — proven to improve final adult height by 10–15cm in CKD.
School and education
Almost all UK children with CKD attend mainstream school. Practical support:
- INDIVIDUAL HEALTHCARE PLAN (IHCP) — agreed between school, family and paediatric renal team. Covers medications, fluid/dietary needs, fatigue management, toilet access, sick day plans.
- EHCP (Education, Health and Care Plan) — formal legal document if more support is needed.
- Hospital school during inpatient stays.
- Disability Living Allowance (DLA) for under-16s — supports the family with the cost of care.
- Catch-up tutoring if illness affects attendance.
Kidney Vitality is a daily multivitamin developed by a UK Consultant Nephrologist using renal nutrition principles. It contains no added potassium, magnesium, phosphorus or iron, and no herbal blends. See the formulation.
Mental health and teen years
Children and teens with CKD have higher rates of anxiety, depression and low self-esteem (visible scars, growth differences, dietary restrictions, dialysis catheters). Look out for:
- Withdrawal from friends
- School avoidance
- Refusing medications
- Risk-taking behaviour
Support:
- Paediatric psychologist (every UK renal unit has one).
- School counselling.
- Peer support: Kidney Kids UK, Teens Unite Fighting Cancer/illness, Kidney Care UK youth events.
- Family therapy where useful.
Transition to adult services
Transition is a planned multi-year process, NOT a single transfer:
- AGE 12–14: introduction to transition concept, begin self-management skills.
- AGE 14–16: structured transition meetings, joint paediatric/adult clinics, condition knowledge assessment.
- AGE 16–18: transfer to adult care, often via dedicated 'Young Adult Clinic'.
Key skills the teen should master before transfer:
- Name their condition and key medications.
- Know their renal team contact details.
- Order their own prescriptions.
- Book their own clinic appointments.
- Understand their personal warning signs.
UK paediatric renal centres
13 specialist paediatric nephrology centres across the UK including:
- Great Ormond Street Hospital (London)
- Evelina London Children's Hospital
- Manchester Royal Manchester Children's Hospital
- Birmingham Children's Hospital
- Bristol Royal Hospital for Children
- Leeds Children's Hospital
- Newcastle Royal Victoria Infirmary
- Nottingham Children's Hospital
- Sheffield Children's Hospital
- Cardiff Noah's Ark Children's Hospital
- Glasgow Royal Hospital for Children
- Belfast Royal Belfast Hospital for Sick Children
Referral via GP or local paediatrician.
