Early kidney transplant must for children with renal failure

Early transplant of kidney is important for children diagnosed with advanced kidney failure, said a senior nephrologist on Wednesday at the local Kavery Hospital, where two boys underwent successful kidney transplant recently.

Speaking to reporters, R. Balasubramaniyam, Chief Nephrologist, said when the kidney failure in children reaches advanced stage, one should do pre-emptive kidney transplant.

“Once the child is identified to have chronic renal failure in the initial stages, the aim of treatment consists of controlling diet, controlling blood pressure, aiding bone growth, and maintaining haemoglobin and acid base equilibrium,” he said.

“But once the kidney failure reaches an advanced stage, we should do pre-emptive kidney transplantation,” he added.

According to him, kidney transplant for an adult can wait till the kidney failure reaches advanced stage.

“But, in children, we should do transplant early, because the child with kidney failure will start having growth retardation and bone changes that may become permanent. Also, it is difficult to do dialysis on a child, who is going to be increasingly non co-operative to treatment,” Balasubramaniyam said.

He said one of the boys — a nine-year-old kid, who had undergone transplant — had congenitally mal-developed kidneys with high blood pressure, requiring multiple blood pressure medications and acid accumulation, making it difficult to control with medications alone.

“The other boy, 11, had posterior urethral valve that led to recurrent urinary infection that further led to kidney failure. Both children have done well post-transplantation and completed one month after surgery,” said Balasubramaniyam.

In both cases, the mother was identified as the renal donor.

As to the transplant challenges where the organ recipient is a child, Jeevagan, the transplant surgeon and urologist said technically it is difficult to keep the adult kidney inside a child’s body.

At the time of surgery, the donor kidney blood tubes are bigger than the child and this warrants the kidney to be kept inside the abdomen, close to the vital organs and connections are even made to greater blood vessels, he said.

Once the blood tubes of the adult kidney are connected to the child’s body and the blood flow is resumed, the adult kidney can hold most of the child’s blood and the child could develop dangerous low blood pressure, Jeevagan said.

Also, soon after the surgery the adult kidney will start passing several litres of urine and the child’s blood volume is smaller and if not properly managed, it may lead to drop in the blood volume, kidney failure or disturbances in acid base balance and electrolyte balance can go haywire.

Some children are born with congenital abnormalities of the urinary tract that lead to recurrent urinary infections and kidney failure.

The kidneys also fail due to large quantities of protein leakage in the kidneys called nephrotic syndrome and this will lead to kidney failure especially when the children don’t respond to treatment, Aravindan Selvaraj, Executive Director, said.