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Las principales recomendaciones son una dieta baja en sal y en potasio. Se debe evitar una tensión arterial elevada por lo que la restricción de líquidos es esencial, en este caso el nefrólogo indicará la cantidad de líquido que puede beber.
A cada niño se le calculará la cantidad de proteínas y calorías que debe ingerir según en qué etapa del crecimiento se encuentre, su estado nutricional y la gravedad de su insuficiencia renal.
Los alimentos procesados están poco o nada recomendados por la elevada cantidad de sal que llevan.
Calidad de vida
Los padres son el principal apoyo del niño ejerciendo una función protectora. Muchas de las situaciones a las que se deben enfrentar pueden ser dificultades en los juegos, cuidados técnicos, trastornos emocionales y dentro de la familia, problemas de autoestima, etc.
Los niños con insuficiencia renal crónica son más vulnerables al impacto de la enfermedad, ya que están aún desarrollándose como personas y dependen de su familia en todos los sentidos. Los padres tienen un gran riesgo de sufrir ansiedad y depresión.
Aquí la ayuda de todo el equipo multidisciplinar cobra vital importancia a la hora de asesorar y tranquilizar a los padres, respecto al tipo de cuidados que su hijo requiere en el domicilio, tipo de actividades que puede realizar, procurando que su día a día se vea lo menos afectado posible dentro de la enfermedad.
The causes of chronic renal disease in paediatrics are different from those of adulthood and are due to several reasons, among which are, from higher to lower percentage, malformations of the urinary tract and kidney, hereditary diseases and glomerular nephropathies. In the case of infants and children, congenital malformation, as well as hereditary diseases such as polycystic kidney disease, are the most common causes of chronic kidney disease. In autosomal recessive polycystic renal disease, its main characteristic is the varying degrees of renal and hepatic involvement, causing a high percentage of children to have end-stage renal failure.
At the microscopic level, a multitude of cystic formations are observed that are distributed through both the marrow and the cortex. On the other hand, glomerulocystic renal disease is a rare congenital disease, characterized by cystic dilation of Bowman spaces and dilation of proximal collecting tubules. In congenital malformations, prenatal ultrasound monitoring allows this diagnosis to be made from newborns.
In children from 12 years of age (adolescents), the most common cause of renal failure is glomerulonephritis, in which the glomeruli, which are a tiny filtration units in the kidney, ignite, causing incorrect functioning of this organ. This leads to a series of problems, such as edema ,there is fluid retention in different parts of the body, or renal insufficiency, although the latter is fortunately more rare.
Among the causes that can cause its appearance, apart from the hereditary ones, may be:
-The post-streptococcal glomerulonephritis, which can manifest itself a few weeks after a throat infection by streptococcus.
-Bacterial endocarditis is associated with glomerulonephritis, without it being very clear how the two are related.
-Viral infections such as HIV, hepatitis B and hepatitis C can also cause this condition.
Lupus, Goodpasture syndrome and immunoglobulin A nephropathy ,are other diseases that can lead to glomerulonephritis.
-Among them , granulomatosis with polyangitis, known as Wegener’s granulomatosis and polyarteritis affect medium and small vessels of the kidneys, apart from other organs.
Among the causes that can cause scarring of the glomeruli are also:
-High blood pressure , which can cause the alteration of normal renal function. In turn, glomerulonephritis can also cause hypertension, affecting kidney function.
-Diabetic nephropathy, which may affect any patient with diabetes but can be prevented or delayed by control of blood glucose levels and blood pressure.
Glomerulonephritis may be acute or chronic and the main goal should be to prevent damage to the kidneys from progressing.
The main signs and symptoms of chronic kidney disease in children are:
-More deficient growth compared to similar ages
-Swelling of the tissue surrounding the eyes and ankles
-Loss of appetite
-Headaches from high blood pressure
Complications of chronic kidney disease:
-Among the haematological complications ,includes anaemia, which appears due to a decrease in the production of erythropoietin at renal level and is currently treated with erythropoiesis-stimulating agents, platelet dysfunction and immune deficiency are other alterations of this section.
-One of the main endocrine alterations is related to growth, being somewhat lower due to restrictions in the intake of phosphorus, proteins, …etc… and also because of vitamin D deficiency. Intestinal phosphorus fixators and synthetic growth hormone have improved this aspect.
-High blood pressure and volume overload are some of the most prominent cardiovascular complications
-At the hydroelectrolyte level, the most common is the presence of hypocalcaemia and hyperphosphorymia. In advanced chronic renal insufficiency, severe acidosis and hyperkalaemia mainly occur in patients with diabetes mellitus or taking certain drugs such as Ace inhibitors, non-steroidal anti-inflammatory drugs, beta-blockers…
-Gastrointestinal diseases include nausea and vomiting, as well as gastritis, pancreatitis, gastrointestinal haemorrhages When the kidneys are no longer able to perform their function, dialysis is the required treatment.
Haemodialysis and peritoneal dialysis may be chosen, depending on the case.
Through a machine, the patient’s blood is filtered through a membrane, releasing it with substances toxic to the body. The connection is made either to a fistula or to a catheter. The arterio-venous fistula is performed by surgery, joining an artery and a vein ; it must be spent some time before being used, approximately a month, being durable and with few complications, with precautions for proper maintenance( no lifting of weight, not taking blood pressure or blood tests…etc.)
The blood extracted from the vein passes through the hemodialysis machine being filtered and returned to the patient’s organism through the artery, free of waste substances and with an adequate concentration of salts and ions , contributing to adequate blood pressure figures by eliminating excess fluids. If an arterio-venous fistula is not possible or not working, the next option is to place a catheter in a thick vein, usually in the neck or groin. This would be connected to the machine by producing the filtering of the blood as described above. In this case the possible complications are the risk of infection or obstruction.
The frequency of this treatment is usually around 3 days a week, usually around 4 hours, although the specific weight and severity characteristics of each child may alter this standard.
In this case, the filter used is the patient’s own peritoneum. An intraabdominal catheter is placed through surgery. Through it, the dialysis fluid is introduced, which must remain inside the body for a while to attract the waste substances that will then be dragged and removed to the outside next to the liquid. These entry and exit passages are called exchanges.
The frequency of this technique is usually 4 or 5 times a day. It is done at home, manually, after a previous training to the parents. If the option is chosen to carry out this technique through a machine, it is programmed during the night and the exchanges are carried out without waking the child (these would be more frequent and shorter stay).
These two treatments can be performed until recovery in case of acute renal insufficiencies, or until the arrival of a transplant or for life, in chronic renal insufficiencies.
The main recommendations are a diet low in salt and potassium. A high blood pressure should be avoided so the restriction of liquids is essential, in this case the nephrologist will indicate the amount of liquid you can drink. Each child will be assessed for the amount of protein and calories he or she should eat depending on what stage of growth he or she is in, his or her nutritional status and the severity of his or her kidney failure. Processed foods are little or no recommended because of the high amount of salt they carry.
Quality of life
Parents are the child’s main support in exercising a protective role. Many of the situations that they have to face can be difficulties in games, technical care, emotional disorders and within the family, problems of self-esteem, etc.
Children with chronic kidney failure are more vulnerable to the impact of the disease as they are still developing as people and depend on their family in every way. Parents are at high risk for anxiety and depression.
The help of the entire multidisciplinary team becomes vital when it comes to advising and reassuring parents, regarding the type of care your child requires at home, type of activities he can perform, by ensuring that their day-to-day life is as little affected as possible within the disease.
En los casos de enfermedad renal crónica en niños que requieran de diálisis, el principal objetivo debería ser, aparte de que las funciones del riñón sean sustituidas por este tratamiento, repercutir lo menos posible en su calidad de vida, con la ayuda de todos los profesionales que intervienen en este proceso ( nefrólogos, personal de enfermería, psicólogos, nutricionistas…) y que deben facilitar, en la medida de lo posible, la adaptación a esta situación.
In cases of chronic kidney disease in children requiring dialysis, the main objective should be, apart from kidney functions are substituted by this treatment, to have as little impact on their quality of life as possible, with the help of all professionals involved in this process ( nephrologists, nurses, psychologists, nutritionists…) and who should facilitate, as far as possible, adaptation to this situation.
BIBLIOGRAFÍA / BIBIOGRAPHY:
- Rebollo-Rubio, Ana et al. Revisión de estudios sobre calidad de vida relacionada con la salud en la enfermedad renal crónica avanzada en España. Nefrología (Madr.), 2015, vol.35, no.1, p.92-109. ISSN 0211-6995
- Padullés-Zamora, Núria et al. Utilización de eritropoyetina beta pegilada en enfermedad renal crónica en estadio 3, 4 o 5 no-D.Nefrología (Madr.), 2012, vol.32, no.2, p.221-227. ISSN 0211-6995
- Crump C, Sundquist J, Winkleby MA, Sundquist K. Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study. BMJ. 2019 May 1;365:l1346. doi: 10.1136/bmj.l1346.
- Nogueira PCK, Konstantyner T, Carvalho MFC, Pinto CCX, Paz IP, Belangero VMS, Tavares MS, Garcia CD, Neto OAF, Zuntini KLDCR, Lordelo MDR, Oi SSP, Damasceno RT, Sesso R. Development of a risk score for earlier diagnosis of chronic kidney disease in children. PLoS One. 2019 Apr 19;14(4):e0215100. Doi: 10.1371/journal.pone.0215100. eCollection 2019.
- Park B, Lee JW, Kim HS, Park EA, Cho SJ, Park H. Effects of Prenatal Growth Status on Subsequent Childhood Renal Function Related to High Blood Pressure. J Korean Med Sci. 2019 Jul 1;34(25):e174. doi: 10.3346/jkms.2019.34.e174.
- Hsu CN, Lu PC, Lo MH, Lin IC, Chang-Chien GP, Lin S, Tain YL. Gut Microbiota-Dependent Trimethylamine N-Oxide Pathway Associated with Cardiovascular Risk in Children with Early-Stage Chronic Kidney Disease. Int J Mol Sci. 2018 Nov 22;19(12). pii: E3699. doi: 10.3390/ijms19123699
- special issue: “Focus on pediatric nephrology”, Chimenz R, Fede C, Di Benedetto V, Concolino D, Scuderi MG, Salvo V, Gitto E, Cucinotta U, Viola V, Betta P, Cannavò L, Cuppari C. Hemodialysis in children: how, when and why. J Biol Regul Homeost Agents. 2019 Sep-Oct;33(5 Suppl. 1):87-89
- Hill T, Haut C. Adolescents with Chronic Kidney Disease. Nephrol Nurs J. 2019 Sep-Oct;46(5):533-541.
- Moore T, Brightman S, Dodson DL, Warady BA. Arteriovenous Buttonhole Access Cannulation in Pediatric Patients on Hemodialysis. Nephrol Nurs J. 2019 Jul-Aug;46(4):407-411.
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