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School Age Children & Chronic Kidney Disease

By: Heeyeon No, Karis Kelly, Ana Chong, Callie Shepherd, Madison Philips, & Sydney Yancey

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Background

  • Why is this important?
    • Diagnosis.
      • Chronic kidney disease is the gradual loss of kidney function, which then leads to dangerous levels of fluid, electrolytes, wastes building up in the body.
      • Pediatric CKD can be considered its own branch of the disease due to its different impact on the body during childhood than in adulthood.
    • Which system of the body is impacted?
      • The main system impacted by CKD is the excretory/urinary system in the body.
      • Due to growth impairment, physically and developmentally, one sees the endocrine system impacted.
      • The skeletal system is also affected as childhood CKD patients can suffer from mineral and bone disorder.
      • Due to anemia, a complication of childhood CKD, leading to depressed neurocognitive ability, reduced exercise capacity and progression of cardiovascular risk factors the nervous and cardiovascular systems impacted by this disease.
    • It is a major health problem worldwide due to its increasing incidence
    • Can have many long-term consequences
    • Presents unique features in childhood
    • It is often asymptomatic, especially in earlier stages

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Background

  • Context
    • How many children have this condition? Rare or common?
      • Chronic kidney disease is relatively uncommon for children.
    • What is the treatment and prognosis?
      • Treatment:
      • It depends on what the cause of the kidney disease is.
      • Kidney disease can cause high blood pressure which is treated with medication. Improving this blood pressure can help slow the progression of the kidney disease.
      • The health care provider may prescribe:: (Two or more of these medications are often needed.)
        • angiotensin-converting enzyme (ACE) inhibitors, which help relax blood vessels and make it easier for the heart to pump blood; angiotensin receptor blockers (ARBs), which help relax blood vessels and make it easier for the heart to pump blood; diuretics, medications that increase urine output
      • As the kidney’s function declines, children may need treatment for anemia and growth failure
        • For anemia: they will need the hormone erythropoietin “which stimulates the bone marrow to produce red blood cells
        • For growth failure: dietary changes, food supplements, or growth hormone injections
      • If the kidney disease leads to kidney failure, the individual will be treated with either dialysis or transplantation
      • Prognosis:
      • Could progress to kidney failure and increased risk of cardiovascular disease
      • Early recognition and treatment are seen to be very beneficial.
    • What kind of symptoms are experienced both from the illness and the treatment?
      • Anemia, anorexia, nausea, vomiting, bone disease (termed osteodystrophy), cardiovascular disease, hyperkalemia, hypertension, metabolic acidosis, volume overload

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Developmental theories

  • Erikson’s Psychosocial Theory
    • Fourth stage: Industry vs. inferiority
    • Encourage or discourage self-confidence
  • Stress and Coping Theory (Lazarus and Folkman)
    • Stress can exacerbate symptoms of illness, and chronic illnesses present enough stress and demands
  • The main theme that these theories have in common with this age group is a sense of autonomy and control

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Effect of trauma, hospitalization, and development

School-age Stages

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Erickson’s: Industry vs. Inferiority

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Piaget’s: Concrete Operational

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Kohlberg’s: Conventional

Hospital Risks

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Loss of control

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Fear of bodily mutilation

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Illness, disability, and death

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Tools, resources, or interventions available

Tools

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Kidney Disease Complication Treatments:

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  • High blood pressure medications
  • Medication to lower cholesterol levels
  • Medications to relieve swelling

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End-Stage Kidney Disease Treatments:

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  • Dialysis
  • Kidney Transplant

Resources

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  • American Association of Kidney Patients (AAKP)

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  • National Kidney Foundation

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  • American Nephrology Nurses’ Association (ANNA)

Psychosocial Interventions

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  • Support groups

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  • Maintain normalcy when possible

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  • Being active

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Created tool- Dialysis Buddy

  • The child makes the toy at one of their first treatments and can bring back to each
    • lengthier project may help a child ease into the process.
  • Could help with..
    • adjustment issues commonly experienced by children with this condition (Kang et al., 2019)
    • Nervousness about treatments

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Activities

  • Can act as a comfort tool → Put the “IVs” on their buddy when their treatment begins

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  • Can be used to teach the child about their condition and treatment

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  • Child can use it to teach peers about it

Prompts child to observe what is happening to them and learn about it which promotes agency in the face of a morale depleting condition (Kiliś-Pstrusińska et al., 2013).

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Resources

Becherucci, F., Roperto, R. M., Materassi, M., & Romagnani, P. (2016). Chronic kidney disease in children. Clinical kidney journal, 9(4), 583-591.

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Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual review of clinical psychology, 8, 455–480. https://doi.org/10.1146/annurev-clinpsy-032511-143108

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Francesca Becherucci, Rosa Maria Roperto, Marco Materassi, Paola Romagnani, Chronic kidney disease in children, Clinical Kidney Journal, Volume 9, Issue 4, 1 August 2016, Pages 583–591, https://doi.org/10.1093/ckj/sfw047

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Kiliś-Pstrusińska, K., Medyńska, A., Chmielewska, I. B., Grenda, R., Kluska-Jóźwiak, A., Leszczyńska, B., ... & Tkaczyk, M. (2013). Perception of health-related quality of life in children with chronic kidney disease by the patients and their caregivers: multicentre national study results. Quality of life research, 22(10), 2889-2897. https://doi.org/10.1007/s11136-013-0416-7

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Kang, N. R., Ahn, Y. H., Park, E., Choi, H. J., Kim, S. H., Cho, H., ... & Cheong, H. I. (2019). Mental health and psychosocial adjustment in pediatric chronic kidney disease derived from the KNOW-Ped CKD study. Pediatric Nephrology, 34(10), 1753-1764.

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Pascoe MC, Thompson DR, Castle DJ, McEvedy SM and Ski CF (2017). Psychosocial Interventions for Depressive and Anxiety Symptoms in Individuals with Chronic Kidney Disease: Systematic Review and Meta-Analysis. Front. Psychol. 8:992. doi: 10.3389/fpsyg.2017.00992

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Resources (additional links)

  • https://www.niddk.nih.gov/health-information/kidney-disease/children#treatment
  • https://emedicine.medscape.com/article/984358-overview#a1
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3319320/
  • https://www.simplypsychology.org/Erik-Erikson.html
  • https://www.simplypsychology.org/kohlberg.html
  • Rowland, T. L. (2012). Everything You Need to Know About Jean Piaget’s Theory of Cognitive Development. BrainMass Inc.
  • https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/diagnosis-treatment/drc-20354527
  • https://aakp.org
  • https://www.kidney.org/patients/resources
  • https://www.annanurse.org/download/reference/practice/pedCKDFactSheet.pdf

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