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Chronic Kidney Disease (CKD)

Summary

Chronic kidney disease (CKD) is a condition where the kidneys lose their ability to function properly over time. It often goes unnoticed until it reaches advanced stages, making early detection crucial. CKD is usually identified through laboratory tests, including markers like protein in the urine (proteinuria), blood in the urine (haematuria), and a reduced glomerular filtration rate (GFR) lasting for more than 3 months.

The most common causes of CKD are diabetes and high blood pressure (hypertension). Both conditions can damage the kidneys over time.

Managing diabetes through glycemic control and maintaining healthy blood pressure are essential in slowing the progression of CKD. Additionally, medications such as renin-angiotensin system blockers and sodium-glucose co-transporter-2 (SGLT2) inhibitors can help protect kidney function, independent of blood pressure and glucose levels.

CKD also increases the risk of developing heart disease, regardless of other conditions like diabetes or high cholesterol.

Diagnosis and When to Seek Help

CKD can only be diagnosed through blood and urine tests that check for:

  • Protein in the urine (proteinuria)
  • Blood in the urine (haematuria)
  • A reduced glomerular filtration rate (GFR), which indicates how well the kidneys are filtering blood

You should consult a healthcare provider if your child experiences:

  • Swelling in the face, legs, or abdomen
  • Unexplained fatigue or difficulty concentrating
  • Urinary changes, such as darker or foamy urine
  • High blood pressure

Management

  • Control blood sugar and blood pressure: For children with diabetes or hypertension, managing these conditions can slow CKD progression.
  • Medications: Drugs that block the renin-angiotensin system and SGLT2 inhibitors may be prescribed to help preserve kidney function.
  • Monitor kidney function: Regular testing to track changes in kidney health and adjust treatment as necessary.
  • Diet and lifestyle changes: Ensure proper hydration, a balanced diet, and regular exercise to support kidney health.

Follow-Up and Monitoring

  • Ongoing kidney function assessments: Regular blood and urine tests to monitor kidney function and prevent further damage.
  • Heart health checks: Since CKD increases the risk of cardiovascular disease, managing heart health is also important.
  • Long-term care: Some children may need ongoing treatments or therapies to support kidney function and prevent complications.

Early diagnosis and treatment of CKD can significantly improve outcomes and prevent progression to end-stage kidney disease.

History and Exam

Key diagnostic factor

  • presence of risk factors
  • fatigue
  • oedema
  • nausea with/without vomiting

Other diagnostic factors

  • arthralgia
  • enlarged prostate gland
  • foamy-appearing urine
  • cola-coloured urine

Risk factors

  • diabetes mellitus
  • hypertension
  • age >50 years
  • childhood kidney disease

Diagnostic Investigations

1st investigations to order

  • renal chemistry
  • estimation of GFR
  • serum cystatin C and cystatin C-based estimation of GFR
  • urinalysis

Investigations to consider

  • kidney biopsy
  • plain abdominal radiograph
  • abdominal CT
  • abdominal MRI

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

      What’s the next step?

      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com