Kidney Health (Nephrology)

The kidneys are responsible for filtering waste products, extra fluids, and toxins from the blood. When the kidneys aren’t working properly – whether due to a congenital (present from birth) condition or an acquired one – many different types of complications can develop.

Children may be referred to Nemours’ board-certified and fellowship-trained nephrologists (doctors who specialize in kidney care) for a wide range of kidney (also called renal) problems. 

Some of the kidney problems we evaluate include:

• hematuria (blood in the urine)
• proteinuria (protein in the urine)
• kidney stones
• urinary tract infections
• bedwetting
• dysfunctional voiding
• high blood pressure (hypertension)
• nephrotic syndrome (a group of symptoms that occur together and include edema—body swelling, protein in the urine, low blood protein levels, and high blood cholesterol)
• polycystic kidney disease (a hereditary disorder in which multiple cysts, at least two or more, form in both kidneys)
• renal tubular acidosis (a condition that involves an accumulation of acid in the body due to the kidneys’ failure to filter urine properly)
• glomerulonephritis (inflammation of the glomeruli, the structures inside the kidney that help to filter the blood)
• effects of structural birth defects on the formation of the urinary tract such as hydronephrosis (swollen kidney), obstruction (blockage), vesicoureteral reflux, and renal agenesis (being born with one kidney)
• multicystic kidney disease (abnormal fetal development that leads to the development of multiple cysts in the place where a kidney should be)
• Fanconi syndrome (a disorder of the small kidney tubes in which certain substances normally absorbed into the bloodstream by the kidneys are released into the urine instead)
• acute renal failure (a rapid, sudden decrease of kidney function due to damage, inflammation, or injury)
• chronic renal failure (a slow worsening of kidney function over time due to disease)
• end-stage renal disease, also called ESRD (when chronic renal failure has progressed to the point that the kidneys are completely or almost completely unable to remove water and clean the blood of toxins)
• Kidney problems associated with autoimmune disease ( when the body’s immune system reacts against itself) such as systemic lupus erythematosus   

Kidney problems that tend to develop in older children include urinary tract infections; high blood pressure, kidney stones (tiny mineral deposits that get lodged in the kidney or urinary tract); nephritis (inflammation of the kidneys); electrolyte imbalances; and kidney damage cased by diseases such as lupus and diabetes, or by drugs or injury.

What We Do

At your child’s first visit, we will perform a thorough physical exam and take a complete family history. We will also likely order blood tests, urine tests, and imaging studies --renal ultrasounds and in certain cases CAT scans or nuclear medicine studies. These tests assess the structure and function of your child’s kidneys. In some cases, depending upon your child’s symptoms and other test findings, a percutaneous (through the skin) kidney biopsy may need to be performed to assist the doctors in finding the diagnosis.

Because many kidney problems overlap with diseases of the urinary tract, we often work closely with specialists from Urology. Other specialists, such as Rheumatologists may also be involved, as in the case of lupus-related kidney disease. Together, we can offer the most up-to-date and effective treatment plan for your child.

Treatment options can vary widely depending on your child’s stage of disease. Some kidney problems may require diet modifications, medication, or surgery to correct an anatomical defect, while others might require long-term dialysis or a kidney transplant. Our staff also has particular expertise in managing the many side effects children experience as a result of renal failure, including stunted growth.

Prenatal counseling is available for women carrying babies with congenital abnormalities such as cystic kidney diseases and hydronephrosis (dilation or stretching of the kidney or ureter which is the tube that drains urine from the kidney)

The End-Stage Renal Disease Program

For children with ESRD, we offer several treatment options, including:

• Dialysis – When the kidneys are no longer able to filter the blood, a machine can do the job for them. Our program offers two types of dialysis:
  • Hemodialysis, which is a process that allows your child’s blood to flow a few ounces at a time through a large machine while a special solution called dialysate removes waste products. The clean blood is then returned to your child’s body. This happens in a hospital and is usually performed several times a week for at least 4 hours
  • Peritoneal dialysis, which uses your child’s abdominal cavity to “clean” the blood. Dialysate fluid is introduced through a long soft tube in the abdomen and flushed out either every night while your child sleeps or several times throughout the day.
    
    Vast improvements in dialysis technology and clinical expertise enable even the smallest children, including newborns, to receive safe, effective dialysis. Peritoneal dialysis is preferentially used to treat young, small patients since families can be trained to handle this procedure at home.

• Continuous renal replacement therapy – This technique, mostly used for inpatients, allows dialysis to occur slowly, over a 24-hour period.
• Kidney transplant - Nearly all kids with end-stage kidney disease eventually receive transplants. If a living related donor can't be found, dialysis may be required until a donor kidney becomes available.

Family Support

The stress of dealing with a chronic disease can be great, for children and parents alike. Our staff includes nurse educators who make sure you understand how to manage your child’s condition at home, a dietitian who can make nutritional recommendations, and a social worker to help you deal with your feelings.

We also provide plenty of peer support too. Adolescents with kidney disease can share mutual concerns in regularly scheduled group meetings conducted by nephrology staff members and with teenage tutors, many of whom are patients themselves.