Pediatric Nephrology: Understanding Kidney Diseases in Children

Introduction:

Pediatric nephrology is a specialized medical field that focuses on the diagnosis, treatment, and management of kidney diseases in children. As a branch of medicine, it addresses various conditions affecting the kidneys and their associated structures in pediatric patients, including infants, children, and adolescents. This article aims to provide an overview of pediatric nephrology, its significance in children's healthcare, and the key aspects related to this field.

Understanding Pediatric Nephrology:

Pediatric nephrologists are medical professionals who specialize in the care of children with kidney-related conditions. They possess expertise in evaluating and treating a wide range of kidney disorders specific to the pediatric population. These conditions may include congenital anomalies of the kidney and urinary tract (CAKUT), urinary tract infections (UTIs), nephrotic syndrome, acute and chronic kidney diseases, renal tubular disorders, and kidney transplantation, among others.

Significance of Pediatric Nephrology:

Pediatric nephrology plays a crucial role in ensuring the optimal health and well-being of children with kidney diseases. The kidneys are vital organs responsible for maintaining fluid and electrolyte balance, regulating blood pressure, and filtering waste products from the bloodstream. When these functions are compromised in children, it can have severe consequences on their growth, development, and overall health. Pediatric nephrologists work collaboratively with other healthcare professionals to diagnose kidney conditions early, provide appropriate treatments, and monitor long-term outcomes, thus improving the quality of life for affected children.

Common Conditions in Pediatric Nephrology:

Nephrotic Syndrome: Nephrotic syndrome is the most common glomerular disease in childhood, characterized by abnormal glomerular membrane permeability leading to massive proteinuria, hypoalbuminemia, and edema. Various treatment approaches, including corticosteroids, immunosuppressive therapy, and emerging therapies like rituximab and mycophenolate mofetil, have shown promise in managing this condition.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): CAKUT refers to a diverse group of structural abnormalities affecting the kidneys, ureters, bladder, and urethra in newborns. It can lead to urinary tract obstruction, vesicoureteral reflux (VUR), or renal dysplasia. Early detection and intervention are essential to preserve kidney function and prevent complications.

Acute and Chronic Kidney Diseases: Children can develop acute kidney injury (AKI) due to various causes such as infections, medications, or systemic illnesses. Chronic kidney disease (CKD) in children may result from congenital abnormalities, hereditary conditions, or acquired kidney diseases. Timely management is crucial to slow disease progression and prevent long-term complications.

Renal Tubular Disorders: Renal tubular disorders encompass a group of genetic conditions that affect the renal tubules' ability to reabsorb or excrete specific substances. Examples include renal tubular acidosis, Bartter syndrome, and Gitelman syndrome. Treatment aims to manage electrolyte imbalances and optimize renal function.

Dr. Sidharth Kumar Sethi

Kidney & Urology Institute

He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of an 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and an Expert committee involved in the formulation of guidelines for Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology” (Editors A Bagga, RN Srivastava). He is a part of the Editorial Board of “The World Journal of Nephrology” and “eAJKD- Web version of the American Journal of Kidney Diseases”. He is a reviewer of Pediatric Nephrology related content for various Pediatric and Nephrology journals.

Nephrotic Syndrome

Most people have two kidneys, one on either side of the body just beneath the ribcage. Healthy kidneys filter the blood and allow small particles of waste products and water to be excreted as urine. Kidneys also play an important role in the control of blood pressure, maintenance of bone health, and formation of red blood cells.

What is nephrotic syndrome?

Nephrotic syndrome occurs when the kidneys leak large amounts of protein (especially albumin) into the urine. It is these proteins which is mainly responsible for holding water in the blood vessels, and when they are lost in urine, their level decreases in the blood which causes the water to come out of the blood vessels and cause swelling (edema).

What causes Nephrotic Syndrome?

In most cases, the exact cause of the nephrotic syndrome is not known. There is no relationship between diet or socioeconomic status of the family. It is non-infectious and does not transfer to other family members.

What are the symptoms?

The most common symptom is swelling (edema). It first appears on the face, especially around the eyes which is most prominent in the morning when the child gets up and decreases by the evening.

Other symptoms include Frothy urine, weakness, and tiredness, passing less urine than usual, recurrent infections, diarrhea.

What is the treatment?

Prednisolone (steroid) is the drug of choice when the child is first diagnosed. Most children respond to this drug with the disappearance of the protein in the urine and loss of swelling within 1-2 weeks (we call this REMISSION). Other drugs like diuretics, ACE inhibitors, etc may be required for symptomatic treatment.

Those who do not respond to steroids are given second-line drugs like Cyclophosphamide, MMF, Levamisole, and other immunomodulators as decided by your doctor according to the individual patient profile.

Conclusion:

Pediatric nephrology is a specialized medical field dedicated to diagnosing, treating, and managing kidney diseases in children. By focusing on early detection, comprehensive evaluation, and appropriate interventions, pediatric nephrologists play a crucial role in improving the health outcomes and quality of life for children with kidney conditions. Collaborative efforts between healthcare providers, ongoing research, and advancements in therapeutic approaches continue to advance the field of pediatric nephrology and benefit young patients with kidney diseases.

To schedule an appointment with Dr. Sidharth Sethi, please contact:

Name: Pediatric Nephrology India

Address: Division of Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001

Phone: 0124-4141414

Website: www.pediatricnephrologyindia.com

July 12, 2023 Tags : Best Child Kidney care in delhi , Dr. Sidharth Kumar Sethi , pediatric nephrology

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