Kidney Atrophy in Infants: Causes, Risks, and Dietary Considerations - Pediatrics

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Renal atrophy


Hello, doctor.
My baby is currently 11 months old.
Around 8 months, he experienced a urinary tract infection, and subsequent tests confirmed vesicoureteral reflux (grades 2 and 3).
During the inflammation, an ultrasound showed that the kidney sizes were over 7 and over 5, indicating hydronephrosis.
At the 11-month follow-up, another ultrasound showed that the kidney measuring over 7 decreased to over 6 (the doctor said it returned to normal), while the kidney measuring over 5 decreased to 4.6 but still shows signs of hydronephrosis.
There is about a 2 cm difference between the two kidneys, and the doctor mentioned the smaller one might be at risk of atrophy.

1.
What is the likelihood of atrophy? Is there still room for growth since my baby is so young?
2.
What is the normal kidney size for an 11-month-old baby in centimeters?
3.
If my baby's kidney is atrophied, what impact could that have on him? Would he need long-term dialysis or similar treatments?
4.
Regarding diet, should there be a limitation on protein intake? I include quinoa in his complementary foods along with meat for protein supplementation; I’m unsure if this might be excessive.
Thank you, doctor, for your patience in reading these questions, and I appreciate your responses.

Xiao Hei, 30~39 year old female. Ask Date: 2022/02/23

Dr. Pei Rensheng reply Pediatrics


Hello: According to statistics, the normal kidney size for infants aged 6-12 months is as follows: for females, the mean is 6.3 cm, with a standard deviation of 0.68 cm, and a range of 5.1-7.5 cm; for males, the mean is 6.4 cm, with a standard deviation of 0.78 cm, and a range of 5.4-7.4 cm.
The normal kidney size for adults is approximately 9-11 cm.
Unless there is severe scarring due to kidney inflammation, the kidneys should continue to grow after nephritis.
Blood tests can determine kidney function, and based on the current situation, there is no risk of dialysis (kidney failure) in the short term.
If blood tests reveal any abnormalities in kidney function, dietary adjustments may be necessary! Wishing you health and safety! Sincerely, Ren Sheng.

Reply Date: 2022/02/23

More Info


Understanding kidney atrophy in infants is a complex issue that requires careful consideration of various factors, including the underlying causes, potential risks, and dietary implications. In your case, your 11-month-old baby has experienced urinary tract infections and has been diagnosed with vesicoureteral reflux (VUR), which can lead to kidney complications, including hydronephrosis and potential kidney atrophy.

1. Likelihood of Atrophy: The risk of kidney atrophy largely depends on the severity and duration of the underlying condition, such as VUR and hydronephrosis. In infants, kidneys are still developing, and there is a possibility for growth and recovery. If the smaller kidney is showing signs of atrophy, it is essential to monitor its function closely. Regular follow-ups with a pediatric nephrologist are crucial to assess kidney function and size over time. If the kidney continues to grow and function normally, the risk of significant atrophy may be lower.

2. Normal Kidney Size: For infants, normal kidney size can vary, but generally, the length of a kidney in an 11-month-old should be approximately 6 to 8 cm. The size can differ based on the child's overall growth and development. Your child's measurements of 7+ cm and 5+ cm (which has now reduced to 4.6 cm) indicate a potential concern, especially with the size difference between the two kidneys. It is essential to discuss these measurements with your pediatrician or nephrologist to understand their implications fully.

3. Impact of Atrophy: If kidney atrophy occurs, it can affect the kidney's ability to filter waste and maintain fluid and electrolyte balance. In severe cases, it could lead to chronic kidney disease, which may necessitate treatments such as dialysis or kidney transplantation. However, this is typically a last resort, and many children with mild to moderate kidney issues can manage their condition with regular monitoring and appropriate medical care.

4. Dietary Considerations: Regarding dietary protein intake, it is essential to balance your child's nutritional needs without overloading their kidneys, especially if there are concerns about kidney function. While protein is vital for growth and development, excessive protein can put additional strain on the kidneys. The recommended dietary allowance for protein in infants is about 1.5 grams per kilogram of body weight. If your baby is consuming a variety of foods, including meat and quinoa, it is crucial to ensure that the total protein intake does not exceed this recommendation. Consulting with a pediatric dietitian can provide personalized guidance based on your child's specific health needs.

In summary, while there are risks associated with kidney atrophy, especially in the context of urinary tract infections and VUR, there is also potential for recovery and growth in infants. Regular monitoring, appropriate medical care, and careful dietary management are key to supporting your child's kidney health. Always consult with your healthcare provider for tailored advice and follow-up care.

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