Kidney failure - in children

Kidney failure in children is classified as a rare disease with the most common causse being congenital malformations of the kidney and urinary tract.

Kidney failure is defined as a severe impairment of kidney function (GFR <15 ml/min/1.73 m²). It is rare in children and is therefore classified as a "rare disease." The most common causes are congenital malformations of the kidneys and urinary tract (CAKUT) or other congenital kidney diseases. There is often no curative treatment, which is why kidney replacement therapy, such as dialysis or kidney transplantation, may become necessary.

The primary symptoms of kidney failure include fatigue, reduced appetite, and nausea. Many individuals experience decreased urine production, edema, and high blood pressure. However, in children, kidney failure may present with increased urine production due to a reduced ability to concentrate urine.

Kidney failure is typically diagnosed through blood tests. Once diagnosed, additional tests may be needed to assess and rule out potential complications of kidney failure, including hypertension, rickets, heart failure, and others.

The optimal treatment for kidney failure is kidney transplantation. This involves receiving a kidney from either a living or deceased donor who has consented to donate one of their kidneys. Transplants from living donors generally result in slightly better outcomes compared to those from deceased donors.

Prior to transplantation, various tests, including crossmatch tests, are conducted to ensure that the recipient does not have antibodies that might lead to transplant rejection post-surgery. The best results occur when there are no antibodies against the surface antigens on the new kidney. However, antibodies against common blood group antigens (ABO) are typically not problematic, as they can be removed through immunoadsorption prior to surgery. Karolinska University Hospital was among the pioneers in using this technique, and the results at Karolinska are equally excellent for both blood group-compatible and blood group-incompatible kidney transplants.
If no suitable living kidney donor is available, the patient can be placed on a waiting list to receive a kidney from a deceased donor. In some cases, dialysis may be required temporarily while awaiting a compatible kidney.

There are two main types of dialysis: peritoneal dialysis and hemodialysis. Dialysis generally restores about 20% of normal kidney function, while a successful kidney transplant can restore between 50% and 100% of normal kidney function. At Astrid Lindgren Children's Hospital, we offer all three treatment options.