When we think of kidney disease, we often picture an older adult battling high blood pressure or diabetes. But what if the real danger is actually lurking in children? Have we misunderstood the signs? Are the kids issues undetected? Pediatric kidney disease are rarely talked about, yet they can have lifelong consequences. Unlike adults, who have clear signs, children often exhibit symptoms so subtle that even the most attentive parents and doctors could miss it.

Dr Narendra Shetty, Chief Wellness Officer at Kshemavana emphasizes, "Kidney diseases in children often go unnoticed because their symptoms mimic common childhood conditions. Early detection is key to preventing long-term complications."

The Silent Symptoms

A child who frequently wets the bed or seems tired throughout the day could very easily be dismissed by calling him "lazy" or saying that he is just "going through a phase". But what if that bedwetting is a sign of an underlying kidney disorder? What if their fatigue signals something far more serious than just a lack of sleep?

Adults show obvious symptoms like swelling, high blood pressure, or reduced urine output. However, for children, it may be easier to overlook. Poor appetite, developmental delays, and general fatigue are often attributed to other childhood conditions or simply brushed off as normal. And for infants and toddlers—who cannot verbally express their discomfort—signs like excessive crying, restlessness, or irritability are often misunderstood, delaying crucial diagnoses.

Dr. Shetty explains, "Children may not always communicate their discomfort effectively, making it crucial for parents and pediatricians to stay vigilant for subtle signs of kidney dysfunction."

The concern is that the symptoms kids go through, often falls under the same category of common childhood infections. A child suffering from frequent urinary tract infection (UTI), could actually be vesicoureteral reflux (VUR), a condition where urine flows backward from the bladder to the kidneys, potentially causing long-term damage. However, because UTIs are more common in children, the actual condition may go undetected.

Routine kidney function tests (RFTs) are rarely conducted in children unless there’s a specific reason. This lack of screening means many kidney issues remain hidden until the disease has progressed significantly, making treatment more complex and the impact more severe.

Why Pediatric Kidney Diseases Are Different?

In adults, kidney diseases are more often than note linked to lifestyle choices. However, in pediatric conditions, they are congenital or genetic. Some of the children are born with structural abnormalities that impair kidney function from the start. These conditions, if left undiagnosed can stunt physical growth. They could also delay developmental milestones and lead to long-term health complications.

Children’s kidney diseases also tend to progress differently. They may remain silent for years, only surfacing when the damage is irreversible. In contrast, adult kidney disease usually progresses slowly, with symptoms appearing over time due to factors like hypertension or diabetes.

Is Kidney Health Only About Drinking Water?

If you think like this, then you may need to think again. Maintaining a healthy kidney is more than just drinking water. It has a lot to do in what you eat and what don't you eat. A high-sodium diet can raise blood pressure, putting unnecessary stress on the kidneys. Processed foods loaded with sugar and preservatives are equally harmful. Encouraging home-cooked meals over packaged snacks can go a long way in protecting children’s kidney health.

Hydration plays a key role in maintaining kidney function. While dehydration can cause kidney stones and urinary tract infections, excessive fluid intake in children with conditions like nephrotic syndrome can lead to swelling and other complications.

But diet alone isn’t the only villain. Environmental factors—such as exposure to heavy metals in contaminated water, pesticide-laden foods, air pollution, and overuse of certain medications—can silently damage the kidneys over time. Long-term exposure to toxins like arsenic, lead, and mercury can cause severe renal impairments, yet many parents remain unaware of these hidden dangers.

Dr. Shetty warns, "Children are more vulnerable to environmental toxins than adults. Clean water, organic foods, and limiting unnecessary medications can go a long way in safeguarding their kidney health."

Chronic Kidney Disease

In children with chronic kidney disease or CKD, dialysis and kidney transplants have long been the option. However, science could do more. One breakthrough in pediatric kidney care is the recombinant growth hormone (rGH) therapy which helps improve growth in children with CKD who suffer from malnutrition and stunted development.

Emerging treatments such as stem cell therapy and regenerative medicine are also showing promise. Scientists are working on lab-grown kidney tissues that could one day replace damaged kidneys, offering new hope to children who would otherwise require transplants.

A more holistic approach is also gaining traction. Dietary changes, including a low-protein, alkaline-based diet supplemented with omega-3 fatty acids, can slow kidney disease progression. Alternative therapies such as acupuncture, herbal treatments, and even specific yoga poses are being explored to complement traditional medical treatments.

In 1998, a mysterious and deadly illness emerged among pig farmers in Malaysia, later identified as the Nipah virus (NiV), a bat-borne zoonotic pathogen from the Henipavirus genus. It caused severe respiratory illness and encephalitis, claiming over 100 lives and decimating the pig farming industry.

The virus reappeared in Singapore in 1999. Over time, it was clear that the outbreaks weren’t isolated events. NiV had entrenched itself across regions with certain ecological and socio-cultural conditions, particularly in South and Southeast Asia.

Today, NiV is considered one of the World Health Organization's priority diseases for research and development due to its high case fatality rate (up to 100% in some outbreaks), human-to-human transmissibility, and pandemic potential.

25 Years, 754 Cases, 435 Deaths

As of May 2024, there have been 754 confirmed human Nipah cases reported across five countries—Malaysia, Singapore, Bangladesh, India, and the Philippines—with 435 deaths, averaging a staggering case fatality rate (CFR) of 58%

.

The most affected countries are:

• Bangladesh: 341 cases, 241 deaths (CFR 71%)
• India: 102 cases, 74 deaths (CFR 73%)
• Malaysia: 283 cases, 109 deaths (CFR 39%)
• Philippines: 17 cases, 9 deaths (CFR 53%)
• Singapore: 11 cases, 1 death (CFR 9%)

Unlike Malaysia and the Philippines, where the virus spread through intermediate hosts like pigs or horses, cases in Bangladesh and India have been directly linked to bat-to-human transmission—primarily through the consumption of raw date palm sap contaminated by infected fruit bats.

Why Does Nipah Still Exist?

Fruit Bats Are Permanent Reservoirs

Nipah virus resides in Pteropus fruit bats, which are widely distributed across Asia, the Pacific Islands, and even parts of Africa. These bats are natural carriers and do not show symptoms of the disease, making them difficult to monitor or control. NiV RNA and antibodies have been found in bats in at least 15 countries, including India, Cambodia, Indonesia, and Ghana.

Human Habits Enable Spillover

In regions like Bangladesh, seasonal practices such as collecting fresh date palm sap—a delicacy also consumed raw—provide a direct interface between humans and bat secretions. The virus can contaminate sap through bat saliva or urine.

Moreover, in the Philippines, outbreaks were traced to the butchering and consumption of sick horses. These recurring interactions with potential intermediary hosts keep the door open for viral spillover.

Human-to-Human Transmission

Although not as contagious as influenza or COVID-19, human-to-human transmission of NiV has been confirmed in Bangladesh and India. Some outbreaks have shown vertical transmission (mother to child) and transmission among caregivers and family members.

This capability increases the risk of community spread, particularly in regions with delayed detection or inadequate isolation infrastructure.

No Vaccine, No Cure

Despite being on the global priority pathogen list, there is no licensed vaccine or specific treatment for Nipah. Management remains supportive, relying on early diagnosis and intensive care. In resource-constrained regions, especially rural South Asia, this becomes a daunting challenge.

Bangladesh and India: The Epicenters of Ongoing Risk

Since 2001, both Bangladesh and India have reported almost every year either isolated or clustered cases of Nipah virus, particularly in Kerala and West Bengal (India) and multiple districts in Bangladesh.

Notably, 2023 saw Bangladesh’s highest ever reported NiV cases and deaths. In 2024, the country reported two cases—both of which were fatal, marking a 100% CFR for the year

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Efforts in both countries have been ramped up. Surveillance now includes:

• Testing date palm sap for contamination
• Educating communities to avoid raw consumption
• Quarantining suspected cases
• Expanding diagnostic labs and outbreak response teams

Still, challenges remain due to cultural habits, lack of rapid testing in rural areas, and public fatigue around health advisories.

The Risk of a Wider Spread

Though human NiV cases have so far been reported only in Asia, the potential for global spread exists. Several factors fuel this concern:

Genetic adaptability: The virus has shown potential for genetic reassortment, raising fears of a more transmissible strain.

Broad geographic distribution: NiV-carrying bats exist far beyond the current outbreak zones.

Environmental change: Deforestation, land-use changes, and climate shifts are bringing bats closer to human habitats.

Global travel and trade: A delayed diagnosis in one international traveler could enable the virus to spread outside endemic zones.

What Needs to Be Done?

A Global “One Health” Approach

The study by Sakirul Khan et al. emphasizes the urgent need for multisectoral collaboration—involving human health, veterinary, and environmental sciences—to monitor and prevent outbreaks

. A “One World, One Health” model is key.

Steps must include:

• Strengthening high-containment laboratories in risk zones
• Continuous monitoring of viral genetic changes
• Developing and testing vaccines and antiviral therapies
• Investing in bat ecology research and habitat protection
• Community engagement and behavioral change strategies

Known for her iconic role as Claire in the Modern Family, Julie Bowen who is a versatile American actress, recently spoke about the rare heart condition she's was diagnosed with at 29.

Speaking about it on the first episode of 'Inside of You' with host Micheal Rosenbaum, Julie revealed her condition 'shy sinus syndrome' that caused her to have a low resting heart rate. She also explained how, due to the condition, she also has had a pacemaker put in place.

Lifelong Low Heart Rate and a Surprising Diagnosis

Bowen explained that she has always had a remarkably low resting heart rate, even around 30 beats per minute at times, a significant deviation from the normal range of 60 to 100 beats per minute for women. This was due to sick sinus syndrome, a heart rhythm disorder exacerbated in her case by hypervagotonia, an overactive vagus nerve. Despite being a competitive runner, her low heart rate was a constant, though initially unexplained, characteristic.

The John Hopkins Medicine explains that sick sinus syndrome (SSS) occurs when your heart's natural pacemaker, the sinoatrial (SA) node in the upper right chamber, becomes damaged and can no longer regulate your heartbeat properly. This damage can result from underlying medical conditions or certain medications, leading to heartbeats that are too slow, too fast, or fluctuate between both extremes.

Recognizing the Symptoms

You might have SSS with no symptoms at all, or only mild ones. However, if symptoms do appear, they can include:

• Dizziness
• Fainting (syncope)
• Shortness of breath, especially with physical activity
• Heart palpitations (a fluttering or pounding sensation in your chest)
• Chest pain

How Is Sick Sinus Syndrome Diagnosed?

The turning point for Julie came thanks to her sister, Annie Luetkemeyer, who had just graduated from medical school. During a family vacation, her sister, still in the habit of carrying a stethoscope, insisted on listening to Bowen's heart. "That is not what they've been telling you, and it's not runner's heart or whatever. That means you need to go to a cardiologist," her sister declared, refusing to let the issue drop

Your healthcare provider might suspect SSS based on your symptoms, but these symptoms can be common to many other conditions. To confirm a diagnosis, your provider will likely perform an electrocardiogram (ECG), which records your heart's electrical activity, rate, and rhythm. If you're not experiencing symptoms during the ECG, the results may appear normal. Other diagnostic tests that may be used include:

Stress test: An ECG performed while you exercise on a treadmill.

Holter monitor: A portable device you wear for over 24 hours to continuously record your heart's electrical activity.

Event recorder: A device worn for several days that records your heart rate only when symptoms occur.

Electrophysiologic testing: A hospital procedure where catheters are threaded into your heart through a vein in your thigh to study its electrical system.

Echocardiogram: An ultrasound of your heart to check for structural problems.

Treatment Options For SSS

About a month after her sister's crucial warning, Bowen was filming the pilot for "Ed" when she was faced with the reality of needing a pacemaker. Initially, the news was daunting. "I was like, 'Oh my God. My life is over. This is so weird. I'm gonna die,'" she recalled. However, doctors explained that while the condition wasn't immediately fatal, it would lead to her frequently passing out.

Bowen described a sensation of lightheadedness, particularly when she was relaxed, feeling "like I'd been holding my breath for a while." The critical warning that solidified her decision was the risk of passing out while driving and potentially harming someone. "Oh, well, then give me the Goddamn pacemaker," she decided.

Her pacemaker is now set to ensure her heart rate doesn't drop below 45 beats per minute. She shared that the surgical insertion was done discreetly through her armpit, leaving no visible scar. While she's had to have the batteries replaced three times, she largely forgets about it now, a testament to how seamlessly it has integrated into her life.

While this is one way to treat her condition, here are some other ways your doctor may choose to go about your treatment,

Medication adjustment

If certain medications are contributing to your SSS, your healthcare provider may change your prescription.

Blood thinners

Because SSS can increase the risk of blood clots forming in the heart and leading to a stroke, you may be prescribed blood thinners as a preventive measure.

Alpha-gal syndrome (AGS) is a potentially life-threatening allergy to red meat and other products derived from mammals. Unlike typical food allergies that cause immediate reactions, AGS symptoms can appear several hours after consumption. These range from hives and nausea to anaphylaxis and, in rare cases, heart attacks. The syndrome is triggered by a sugar molecule called galactose-α-1,3-galactose (or alpha-gal), which is introduced into the human body through the bite of a lone star tick.

Why are lone star ticks spreading?

Lone star ticks, named for the white dot found on the backs of females, have long been native to the southeastern United States. But in recent years, their range has expanded dramatically — now reaching as far north as Maine and westwards toward the central US. Experts say this is largely due to the warming climate, which has made previously inhospitable regions more suitable for tick survival and reproduction.

This spread is also helped by other factors such as:

• Increased deer populations (which host ticks)
• Urban development that pushes human dwellings closer to wild habitats
• Lack of natural barriers, such as mountain ranges, in some regions

How common is AGS?

The true number of alpha-gal syndrome cases is difficult to determine due to inconsistent data collection and lack of awareness. The Centers for Disease Control and Prevention (CDC) has documented about 110,000 cases since 2010, but estimates suggest the actual number could be as high as 450,000. Many people may never realise their allergic reactions are linked to a tick bite.

What makes these ticks dangerous?

Lone star ticks are notoriously aggressive. They are capable of detecting humans by sensing heat and carbon dioxide and will actively pursue a host. They can even move quickly over short distances, increasing the chances of biting.

The concept of a “tick bomb” — a cluster of tiny juvenile ticks that swarm over anything they encounter — adds another terrifying element to their behavior.

Living with alpha-gal

For those diagnosed with AGS, life can change dramatically. Aside from cutting out red meat (beef, pork, lamb), many patients also have to avoid dairy, gelatin, and even some medications, toothpaste, and medical products derived from mammals. Food choices become limited and dining out risky. In severe cases, even airborne particles from cooking meat can trigger a reaction.

Support groups are growing rapidly, especially in affected regions like Virginia, where community members share coping strategies and advocate for clearer food labelling.

What’s next?

As the climate warms and tick populations expand, AGS may affect millions more. Other tick-borne illnesses like Lyme disease, Babesia, and the deadly Powassan virus are also on the rise.

Yet, despite this growing threat, researchers warn that US funding for tick-borne disease research is shrinking. Experts stress the urgent need for better surveillance, education, and treatment options to confront what could become a nationwide health crisis.