Pediatric Nephrology

Pediatric nephrology, one of the sub-branches of the department of pediatric health and diseases, is a medical science that deals with the diagnosis and treatment of kidney and urinary system diseases in children aged 0-18. The kidneys, which provide water, acid-base balance and electrolyte balance in the body, are the organs that filter the blood and provide the excretion of harmful toxins as urine and give information about how much blood will be made into the bone marrow. The urinary system consists of the ureter, bladder and urethra, known as the urinary tract to which the kidneys are connected. In the urinary system, congenital or acquired diseases are diagnosed and treated by pediatric nephrology physicians who have received a total of 13 years of medical education. Specialist physicians prevent the occurrence of irreversible damages such as kidney failure by taking preventive measures to prevent recurrence of the disease. Patients are treated in an outpatient clinic or inpatient in a pediatric nephrology clinic, depending on the condition of the disease.

What diseases does a Pediatric Nephrology doctor look for?

Pediatric nephrology physicians deal with the diagnosis and treatment of the following disease groups, which are among the diseases of the urinary system:

  • Kidney parenchymal diseases
  • Cystic diseases of the kidney
  • Glomerular diseases
  • Tubulointerstitial diseases
  • Kidney involvement due to systemic diseases

For the diagnosis of all these nephrological disease groups, blood and urine tests are performed in biochemistry and microbiology laboratories. When necessary, examinations involving advanced imaging methods such as ultrasound (doppler), voiding cystourethrography, intravenous pyelography, computed tomography, magnetic resonance (MR) are performed by radiology. In addition, kidney scintigraphic examinations called DMSA, DTPA, MAG-3 are also applied by the nuclear medicine branch. Some of the most common diseases among these disease groups are given below.

What is Urinary Incontinence?

Urinary incontinence in children is mostly caused by a functional disorder of the bladder known as the bladder. It may rarely be of neurogenic or anatomical origin. Frequent urination and drop-shaped incontinence can be seen due to low bladder capacity. In the case of the lazy bladder, the excessively enlarged bladder has become insensitive to filling. In some patients, stool incontinence accompanying urinary incontinence may also be observed. This situation is due to the dysfunction of the bladder and intestines. Sometimes, history, laboratory and radiological examinations are required for the diagnosis of urinary incontinence, which can be seen with physical activities such as running or laughing. Treatment is performed with medication or surgical operations depending on the diagnosis.

What is a Urinary Tract Infection?

Urinary tract infection is the second most common type of infection after upper respiratory tract infections. Urinary tract infection, which is seen in infants as well as in children, usually manifests with symptoms such as frequent urination, burning while urinating, fever, abdominal pain, nausea and vomiting. Continuous recurrent infection may pose a risk to the kidneys, and conditions such as underlying obstruction, the presence of stones, and urine leakage should be investigated. If there is no different underlying reason, appropriate antibiotic treatment begins when the physician deems it necessary.

What are Kidney Stones and Sand Casting?

Unlike the symptoms seen in adults, the symptoms of stone problems seen in children; It is seen as yellowing of the skin, abdominal pain, loss of appetite, blood in the urine, and sometimes nausea and vomiting. The diagnosis becomes clear with the laboratory analysis and radiological imaging. Depending on the size of the stone, the physician may suggest to wait, but if the symptoms are severe enough to reduce the patient’s quality of life, the stone is broken with endoscopic surgery.

What is Hypertension?

Unlike adults, blood pressure in children varies according to age, height and gender. Considering these differences, hypertension in children is the situation that it should be above the value. Hypertension is about 3 times more common in obese children. Its causes are considered in two different groups as primary and secondary hypertension. Primary hypertension is hypertension of unknown cause, whereas secondary hypertension develops due to hormonal, renal, vascular and neurological diseases and drug use. After the cause of hypertension is determined, appropriate treatment is recommended. In general, the use of diet and medication is recommended for the treatment of hypertension.

What is Hematuria?

The urinary tract infection, structural disorders and urinary trauma. Additional laboratory and radiological examinations may be requested by the pediatric nephrologist after a detailed history and physical examination. If the urea and creatinine values are normal as a result of the blood tests, the patient is followed up at regular intervals. However, if the condition continues, if there is an abnormality in the laboratory tests, inflammation in the kidney tissue, in other words nephritis, can be suspected. In such a case, the physician will request a biopsy to clarify the situation that causes hematuria. In some cases, the presence of stones in the kidney may cause hematuria.

What is Nephrotic Syndrome?

It occurs when the proteins necessary for the body are excreted together with the urine during the filtration process performed by the kidneys, in other words, the kidneys cannot fulfill their functions. It manifests itself with symptoms such as swelling in the legs and eyelids, weight gain due to water retention, and hypertension. Nephrotic syndrome caused by inflammation in kidney tissue can have many causes. For its diagnosis, a kidney biopsy is performed as well as blood and urine tests. After the underlying causes are revealed, appropriate treatment is arranged.

What is Proteinuria?

The condition observed with a protein excretion of more than normal, ie more than 4mg per square meter in an hour, is called proteinuria. It is an important clinical indicator of kidney disease. If left untreated, it may result in kidney failure. It is mostly treated with diet and medication. However, in some cases, a kidney biopsy is required.

What is Vesicoureteral Reflux?

Vesicoureteral reflux, known as retrograde leakage or kidney reflux, is a very common disease in children. The recurrence rate of the disease in children in the community is 35%. Vesicoureteral reflux, which is the condition of urine leaking back to the kidney due to the structural defect of the urinary tract at the point where the bladder opens, is treated with medication or endoscopic surgery.

What is Ureteropelvic Stenosis?

Ureteropelvic stenosis, which is defined as stenosis in the urinary tract, increases the risk of frequent urinary tract infections by making the excretion of urine from the kidney difficult. It is characterized by intense abdominal pain, dark urine, and blood. In older children, it manifests itself with complaints of nausea, vomiting, and pain in the kidney area. Ureteropelvic stenosis can also be detected during routine controls in unborn babies. Considering the possibility of spontaneous recovery, this situation is followed up until the baby is 18 months old. The treatment aims to prevent kidney damage. Ureteral drainage is provided from the pelvis with endoscopic surgery.

What Are Kidney Problems Encountered During Pregnancy?

The kidney functions of the fetus in the womb are covered by the mother. The urine produced by the baby, on the other hand, forms the fluid that the baby swims in the womb, called amniotic fluid. This fluid plays a key role in the development of these areas by filling the baby’s lungs and digestive system. If the kidneys of the baby do not work, amniotic fluid does not fill the lungs and the baby dies in a short time after birth. In some cases, diseases such as urinary tract strictures, vesicoureteral reflux, and kidney cysts can be seen in the mother’s womb. These diseases that can cause kidney damage and failure should be treated before kidney function deteriorates.

What are Hereditary Kidney Diseases?

Autosomal dominant polycystic kidney disease is the most common inherited kidney disease. Diseases such as nephronophthisis, diabetic nephropathy, and Alport syndrome can be seen in children of sick families. In some cases, such as consanguineous marriage, hereditary kidney diseases are seen in their children even though the parents themselves are not sick. In this way, the following diseases that can lead to kidney failure can be seen in children with a genetic inheritance:

  • Polycystic kidney disease
  • Medullary cystic kidney disease
  • Nephrotic syndrome
  • Cystinosis
  • Oxalosis
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