Early Detection and the Importance of Screening for Kidney Disorders in Newborns

By: dr. Eka Laksmi Hidayati, Sp.A, Subsp. Nefro

Kidney disease doesn't just affect adults; it can also affect children, even from birth. Congenital kidney defects (present at birth) are one of the main causes of chronic kidney disease (CKD) in children. Kidney damage can progress slowly without being noticed until the condition is already advanced.
Therefore, early detection through newborn screening is a crucial step in maintaining a child's quality of life in the future.

Why is Newborn Kidney Disorder Screening Important?

Congenital kidney defects, known as CAKUT (Congenital Anomalies of the Kidney and Urinary Tract), often show no symptoms in early life. Symptoms only appear when kidney damage is already quite severe.

Some reasons why screening is important include:

• Preventing serious complications
  Early detection allows for faster medical intervention to slow or halt disease progression. This can prevent complications such as growth retardation, anemia, malnutrition, hypertension, and even permanent kidney failure.
• Timely Intervention
  Abnormalities such as hydronephrosis (enlarged kidneys due to blockage) require close monitoring or immediate medical intervention. Early detection helps doctors plan optimal treatment.
• Improving Quality of Life
  Prompt and appropriate treatment allows children to grow and develop optimally and reduces the risk of developmental delays or the need for dialysis at an early age.
• Reducing Healthcare Costs
  Advanced CKD treatment requires significant costs, such as dialysis or transplantation. Early screening and prevention can reduce these costs.
   

Types of Screening and Early Detection

In Indonesia, Newborn Screening (NSSC) generally includes tests for congenital hypothyroidism and G6PD enzyme deficiency. However, kidney abnormalities can be detected during pregnancy and after birth.

1. Antenatal Ultrasonography (USG)

An ultrasound examination during pregnancy can detect fetal kidney and urinary tract abnormalities, such as:

• Hydronephrosis (enlarged kidney)
• Hydrureter (enlarged urinary tract)
• Multicystic dysplastic kidney (MKD)
• Abnormalities in the size or position of the kidneys

Early detection in the womb allows for optimal birth planning and postnatal care by the medical team.

2. Physical Examination of the Newborn

After birth, the doctor will perform a thorough physical examination, including the abdominal area.
Signs to watch for:

• Lumps in the abdomen or bladder
• Urinary problems or changes in urine

3. Further Examination

If there are risk factors or clinical suspicion, further examination may include:

• Postnatal renal ultrasound
• Urine test, to detect urinary tract infections (UTIs) or proteinuria
• Blood test, to assess kidney function

4. Growth and Health Monitoring

Congenital kidney defects can impact a child's growth. Signs to watch for include:

• Weight or height not in line with the growth curve
• Recurrent urinary tract infections (UTIs)

In these conditions, further evaluation, including an ultrasound, is highly recommended.

Prevention and Follow-up Steps

Early detection is not the end, but rather the beginning of long-term monitoring and treatment. If a baby is diagnosed with a kidney disorder, steps that can be taken include:

1. Regular Monitoring
   Includes regular blood pressure, growth, and kidney function checks.
2. Urinary Tract Infection (UTI) Management
   Prevention and treatment of UTIs are important to prevent further kidney damage.
3. Special Medical Procedures
   In certain cases, such as severe obstructions, surgery may be necessary.
4. Parental Education
   Includes understanding fluid intake, nutrition, and safe medication use for children's kidneys.

Public and medical professional awareness is key to early detection of kidney disorders in children. Parents are encouraged to be open about their family's medical history and to consult a pediatrician, especially if they identify risk factors.
With appropriate screening and prompt intervention, every baby has a greater chance of healthy growth and a fulfilling future.

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