Pediatric Nephrology

Pediatric nephrology is a specialized branch of medicine that undertakes the diagnosis, treatment, and follow-up of kidney and urinary tract diseases in the age group from birth to the end of adolescence. Kidneys are organs that perform vital functions such as filtering the body's waste products, maintaining fluid-electrolyte balance, and regulating blood pressure. Kidney diseases in children may follow a different course than in adults; therefore, evaluation by physicians specializing in pediatric nephrology is of great importance.

Scope of Pediatric Nephrology

The pediatric nephrology department deals with kidney and urinary tract problems of patients from the neonatal period up to the age of 18. This department provides services across a wide spectrum, including congenital structural kidney anomalies, urinary tract infections, nephrotic syndrome, nephritic syndrome, kidney failure, hypertension, kidney stones, and genetic kidney diseases. Additionally, pediatric patients requiring follow-up after kidney transplantation and dialysis treatment also fall within the scope of this department.

Pediatric nephrologists not only treat kidney diseases but also closely monitor the effects of these diseases on the child's growth and development. Multidisciplinary approaches such as nutritional support, growth hormone therapy, and psychosocial support are applied to children with chronic kidney disease.

Common Pediatric Kidney Diseases

Kidney and urinary tract diseases are quite common in childhood. Early diagnosis and treatment of these diseases are critical for preventing permanent kidney damage.

• Urinary tract infections (UTI): These are among the most common kidney problems encountered in children. They are seen more frequently, especially in girls. Recurrent urinary tract infections may indicate an underlying structural anomaly and must be investigated.
• Vesicoureteral reflux (VUR): This is the condition where urine flows back from the bladder into the kidneys. It is one of the most common causes of recurrent urinary tract infections and can lead to kidney damage if left untreated.
• Nephrotic syndrome: A group of diseases that cause excessive protein loss from the kidneys. It manifests in children with generalized edema, foamy urine, and weight gain. While there are forms that respond well to treatment, it can follow a chronic course in some cases.
• Glomerulonephritis: Inflammation of the filtering units of the kidney. Acute post-streptococcal glomerulonephritis is the most common form in children. It presents with symptoms such as blood in the urine, swelling in the face and around the eyes, and high blood pressure.
• Congenital kidney anomalies: Structural disorders such as solitary kidney, horseshoe kidney, polycystic kidney disease, hydronephrosis, and renal agenesis can be detected via prenatal ultrasonography.
• Kidney stones: Kidney stones can form in children due to metabolic disorders, insufficient fluid intake, and genetic factors. Abdominal pain, blood in the urine, and restlessness are the primary symptoms.
• Hemolytic uremic syndrome (HUS): A serious condition characterized by kidney failure, anemia, and low platelet count, usually developing after an infectious diarrhea.
• Tubular diseases: These are functional disorders of the renal tubules, such as renal tubular acidosis, Bartter syndrome, and Fanconi syndrome. They can cause growth retardation, electrolyte imbalances, and bone mineralization disorders.
• Chronic kidney disease: The progressive and permanent decline in kidney functions. In children, it most commonly develops due to congenital structural anomalies and glomerular diseases.
• Enuresis nocturna: Bedwetting should be evaluated if it continues after the age of five. Kidney functions and bladder capacity need to be examined.

Diagnostic Methods

In pediatric nephrology, making an accurate diagnosis forms the basis of appropriate treatment planning. Thanks to modern medical technologies, kidney diseases can be detected at early stages.

• Urinalysis and urine culture: The first and most fundamental examination method in the diagnosis of kidney diseases. The presence of protein, blood, leukocytes, and bacterial growth in the urine is evaluated.
• Blood tests: Kidney function tests (urea, creatinine, cystatin C), electrolytes, complete blood count, serum albumin levels, and complement levels are examined.
• Ultrasonography: A radiation-free, safe, and easily applicable imaging method used for the structural evaluation of the kidneys and urinary tract.
• Voiding cystourethrogram (VCUG): The gold standard method for the diagnosis of vesicoureteral reflux. It allows for the imaging of the urinary tract by administering contrast material into the bladder via a catheter.
• DMSA scintigraphy: Used to evaluate the condition of the renal parenchyma and scar formation. It is important in showing kidney damage in recurrent urinary tract infections.
• MAG-3 scintigraphy: Measures the functional capacity of the kidneys and the rate of urine flow. It is used to determine the severity of hydronephrosis.
• Kidney biopsy: Performed for definitive diagnosis in cases of nephrotic syndrome, glomerulonephritis, and unexplained kidney dysfunction by taking a tissue sample from the kidney for pathological examination.
• Genetic tests: Molecular genetic examinations are applied in the diagnosis of polycystic kidney disease, Alport syndrome, and other hereditary kidney diseases.
• Ambulatory blood pressure monitoring: In cases of suspected hypertension in children, the diagnosis is supported by 24-hour blood pressure measurement.

Treatment Approaches

In pediatric nephrology, treatment is individualized according to the type and stage of the disease. Early and effective treatment is vital for preserving kidney functions and ensuring the child's healthy growth and development process continues.

Medical treatment: Appropriate antibiotic therapy for urinary tract infections, corticosteroids and immunosuppressive drugs for nephrotic syndrome, antihypertensive agents for hypertension, and metabolic regulation for kidney stones form the basis of treatment. Drug dosages in children are meticulously adjusted according to body weight and kidney functions.

Diet and nutritional support: In chronic kidney disease, restriction of protein, sodium, potassium, and phosphorus may be required. Nutrition programs prepared with a dietitian contribute to the preservation of kidney functions and the child's adequate growth.

Dialysis treatment: In advanced stages of kidney failure, artificial purification methods that perform the functions of the kidney are applied. Peritoneal dialysis is a frequently preferred method for children and can be performed at home. Hemodialysis is performed in the hospital and requires regular sessions at specific times.

Surgical treatment: Anti-reflux surgeries for vesicoureteral reflux, and surgical interventions such as percutaneous nephrolithotomy or ureterorenoscopy for kidney stones can be applied. Pyeloplasty surgery is performed in severe cases of hydronephrosis.

Kidney transplantation: It is the most ideal treatment option in end-stage renal failure. Kidney transplantation can be performed from a living donor or a cadaver. Lifelong immunosuppressive therapy and regular follow-up are required after transplantation.

When to Consult a Pediatric Nephrologist?

If your child has one or more of the following signs and symptoms, it is recommended to consult a pediatric nephrologist:

• Change in urine color, foaming, or foul odor
• Pain or burning sensation during urination
• Frequent urination or bedwetting problems
• Swelling in the face, around the eyes, or in the legs
• Unexplained abdominal or back pain
• Recurrent febrile illnesses and urinary tract infections
• Detection of high blood pressure
• Growth and development retardation
• Family history of kidney disease
• Kidney anomalies detected in prenatal ultrasonography
• Abnormal values related to kidney functions in blood and urine tests

Preventive Measures and Family Guidance

Families should be informed about many issues to protect kidney health in children. Ensuring adequate fluid intake, acquiring the habit of not delaying urination, and balanced nutrition are the cornerstones of kidney health. Avoiding salty and processed foods, ensuring the child engages in regular physical activity, and providing adequate fluid intake during febrile illnesses are recommended.

In children with recurrent urinary tract infections, hygiene education, regular toilet habits, and the use of prophylactic antibiotics when necessary can reduce the frequency of infections. For children with chronic kidney disease, not neglecting regular outpatient clinic check-ups, using medications regularly, and adhering to nutritional recommendations slows the progression of the disease.

Why Koru Hospital?

The Koru Hospital pediatric nephrology department provides comprehensive diagnostic and treatment services to pediatric patients with its experienced and specialized staff. Thanks to its modern laboratory infrastructure, advanced imaging technologies, and multidisciplinary approach, each patient is evaluated individually. The pediatric nephrology, pediatric urology, pediatric radiology, and dietitian teams work in coordination to create the most appropriate treatment plan for patients.

In our hospital, our patients' physical and psychological well-being is prioritized through child-friendly environments, detailed information meetings with families, and long-term follow-up programs. Serving a wide spectrum from emergency situations to chronic disease management, our department is a reliable address for your child's kidney health.

At the Koru Hospital Pediatric Nephrology department, our specialist physicians are by your side, applying the most up-to-date diagnostic and treatment methods for your child's kidney and urinary tract health. You can contact us to make an appointment and obtain detailed information.