Renal Failure (Kidney Failure) in Children

Renal failure, also called kidney failure or end-stage kidney disease, is when your child’s kidneys no longer filter their blood sufficiently.

Remarkable Care for Kids

  • Coordination care for high-risk pregnancies: Pediatric nephrologists at Rush University Children’s Hospital work closely with pregnant women and maternal fetal medicine specialists in the Fetal and Neonatal Medicine Center to identify unborn babies who may need dialysis after they are born for kidney problems, including renal failure.
  • Caring for the whole child: Child life specialists at Rush University Children’s Hospital will help your child cope with the emotional, physical and social challenges associated with renal failure.
  • Pain management and supportive: Pediatric supportive and palliative care services at Rush University Children’s Hospital will work with you and your child to manage pain and other symptoms of renal failure.

What is renal failure in children?

The kidneys normally remove waste and extra fluid from a child’s body by making urine. When the kidneys don’t do their job, waste and other substances build up in the blood instead of being removed through the urine.

There are two types of renal failure:

  • Acute renal failure happens suddenly. It can be caused by a medical illness that affects the entire body, kidney infection, injury, or medications. Once the cause is treated, the kidneys usually heal. Sometimes, a blood-filtering treatment called dialysis is used to clear a child’s body of toxins that built up while the kidneys were not working properly.
  • Chronic renal failure happens over time and is usually permanent. It can be caused by acute renal failure that doesn’t improve, a birth defect or a chronic kidney disease. Medication and diet can slow the decline in your child’s kidney function. Ultimately, however, your child will likely need a kidney transplant to treat chronic renal failure.

Renal failure causes

In adults, kidney failure is commonly caused by diabetes and high blood pressure. In children, the causes of kidney failure are different:

  • Certain genetic disorders, or hereditary diseases, run in families and can harm the kidneys. Examples include polycystic kidney disease and Alport syndrome.
  • Birth defects of the kidneys or urinary tract can prevent a child’s kidneys from working properly.
  • Glomerular diseases, such as glomerulonephritis, can damage the filters in the kidneys (glomeruli).

Renal failure symptoms

A child with kidney failure may not have symptoms until their kidney function is less than 15 percent. Then your child may have the following symptoms:

  • High blood pressure
  • Changes in urination, either not enough or too much
  • Retaining fluid
  • Bloody stool
  • Shortness of breath
  • Feeling tired
  • Easily bruises
  • Nausea or vomiting
  • Difficulty concentrating

Care for renal failure at Rush


If your child has symptoms of kidney failure, contact your pediatrician. If your child is already under the care of a pediatric nephrologist (a doctor who cares for children with kidney problems), contact that doctor if your child’s condition changes or worsens.

Your child’s doctor may order the following the tests to diagnose renal failure:

  • Blood tests to monitor your child’s kidney function
  • Imaging tests, such as a renal ultrasound, CT or MRI, to get detailed pictures of your child’s kidneys
  • Renal scintigraphy, which uses a small amount of radioactive material to see how the kidneys are functioning
  • Biopsy, to examine a small sample of your child’s kidney tissue


Depending on the type of renal failure your child has, your child may need short-term or long-term treatment, including dialysis and/or kidney transplant.

Your child may also need treatment to fix what’s causing their kidneys to fail.  This may include medications that suppress the immune system.

Treatment: Dialysis

Dialysis artificially cleans your child’s blood — filtering waste and extra water from your child’s blood — until the kidneys function again. There are two types of dialysis:

  • Hemodialysis uses a machine to pump your child’s blood out, through a filter, and then back to your child’s body. Your child will need this treatment a few times each week.
  • Peritoneal dialysis uses a special solution placed into your child’s abdomen to soak up waste and extra fluid. The used solution is then drained out of your child’s abdomen. The process of draining the solution and adding more solution can be repeated over and over at home while your child sleeps.

Treatment: Kidney transplant

Kidney transplantation is surgery to put a healthy kidney inside your child’s body. The kidney can come from a living kidney donor or some who recently died. After a kidney transplant, your child will need to take medication and get regular checkups to make sure the new kidney is functioning well.

Treating complications

Your child’s care team will also monitor your child for complications of renal failure and treat them when necessary. Your child’s multidisciplinary care team — which may include pediatric nephrologists, pediatricians, pediatric urologists, transplant surgeons and others — will work together to address any of the following possible complications:

  • Anemia: Damaged kidneys may not produce enough of the hormone erythropoietin that helps make red blood cells. Your child may need erythropoietin injections to replace this hormone.
  • Growth problems: The kidneys normally help to regulate phosphorus and calcium levels in your child’s body, which affects bone growth. Medication or injections can help your child grow and improve bone health.
  • Weakened immune system: When waste builds up in your child’s blood, it can make your child more vulnerable to illness. Vaccinations can prevent certain infections.
  • Learning or developmental difficulties: Waste in the blood can slow down nerve and brain function. This may make it hard for your child to concentrate or develop certain skills.