Paediatric Nephrology

What is Pediatric Nephrology

Pediatric nephrology focuses on diagnosing and treating kidney disorders in children. With its unique challenges and intricacies, pediatric nephrology contributes significantly to safeguarding the health and well-being of young patients. Pediatric nephrologists undergo extensive training in both pediatrics and nephrology and are responsible for the comprehensive care of children with a wide range of kidney-related conditions. 

Disorders Treated by Pediatric Nephrologists

The common disorders treated by pediatric nephrologists include:

• Congenital Anomalies: Kidney abnormalities from birth, such as:

1. Congenital kidney anomalies (e.g., renal dysplasia, renal agenesis, horseshoe kidney, etc.)
2. Obstructive uropathy (e.g., posterior urethral valves, ureteropelvic junction obstruction, etc.)
3. Polycystic kidney disease
4. Vesicoureteral reflux (abnormal urine flow from the bladder back into the ureters and kidneys)

• Glomerular Disorders: Conditions that affect the glomeruli (the filtering units of the kidney), such as

1. Glomerulonephritis (inflammation of the glomeruli)
2. Nephrotic syndrome
3. Hematuria (bloody in urine) 

• Tubulointerstitial Disorders: Conditions affecting the tubules and interstitium (intertubular spaces) of the kidneys, such as:

1. Tubulointerstitial nephritis (inflammation of the tubules and interstitium)
2. Renal tubular acidosis (disorders of acid-base balance)
3. Bartter syndrome and Gitelman syndrome (genetic disorders affecting electrolyte balance)

• Hereditary Kidney Diseases: Inherited conditions affecting kidney function, such as:

1. Alport syndrome (a genetic disorder affecting the glomerular basement membrane)
2. Autosomal dominant polycystic kidney disease (ADPKD)
3. Autosomal recessive polycystic kidney disease (ARPKD)
4. Fabry disease, cystinosis, and other metabolic disorders affecting the kidneys 

• Renal Hypertension: High blood pressure related to kidney disorders, such as:

1. Hypertension secondary to renal artery stenosis
2. Hypertensive nephrosclerosis
3. Renovascular hypertension

• Acquired Kidney Diseases: Kidney disorders that develop later in childhood, such as:

1. Acute kidney injury (often due to infections or medications)
2. Chronic kidney disease (resulting from congenital or acquired conditions)
3. Recurrent urinary tract infections leading to kidney damage

• Systemic Diseases With Renal Manifestations: Conditions affecting multiple organ systems, including the kidneys, such as:

1. Systemic lupus erythematosus (SLE) with lupus nephritis (an autoimmune disease)
2. Henoch-Schönlein purpura (HSP) with kidney involvement (inflammation of blood vessels)
3. Diabetes mellitus with diabetic nephropathy 

• Renal Transplantation: Pediatric nephrologists also treat children who have undergone kidney transplantation and address issues related to immunosuppression, graft rejection, and long-term graft function.

Diagnostic Approaches

Accurate diagnosis forms the cornerstone of effective management in pediatric nephrology. The diagnostic modalities employed to evaluate kidney function and identify underlying pathologies include:

• Laboratory tests: Urinalysis, urine protein-to-creatinine ratio, blood tests (electrolytes and creatinine), and serum markers (creatinine and cystatin C) 
• Imaging: Renal ultrasound, Doppler ultrasound, MRI, and CT scans
• Renal biopsy
• Genetic testing
• Functional studies: Renal scintigraphy and ambulatory blood pressure monitoring
• Urinary tract studies: Urodynamic and video urodynamics

Treatment Modalities

Pediatric nephrology includes various treatment modalities to manage kidney disorders in children effectively. These include:

• Medications

1. Immunosuppressive Agents: To manage autoimmune kidney diseases
2. Antihypertensive Medications: To control high blood pressure commonly associated with kidney diseases to prevent further kidney damage
3. Diuretics: To manage fluid retention and edema
4. Antibiotics: To treat bacterial infections affecting the urinary tract or kidneys
5. Erythropoietin-Stimulating Agents (ESAs): To stimulate red blood cell production in children with anemia associated with chronic kidney disease
6. Phosphate Binders and Vitamin D Supplements: To manage mineral and bone disorders in children with chronic kidney disease
7. Antimicrobial Prophylaxis: To prevent recurrent urinary tract infections in children

• Renal Replacement Therapies

1. Hemodialysis: To remove waste products and excess fluids from the blood in children with acute kidney injury or end-stage renal disease
2. Peritoneal Dialysis: To remove toxins and excess fluids in children with kidney failure
3. Kidney Transplantation: To offer a solution for children with end-stage renal disease

• Dietary and Lifestyle Modifications

1. Sodium and Fluid Restriction: To curb fluid overload and hypertension
2. Potassium and Phosphate Control: To manage electrolyte imbalances
3. Protein Restriction: To reduce the workload on the kidneys

• Surgical Interventions

1. Corrective Surgery: To correct structural abnormalities of the urinary tract
2. Nephrectomy: To remove a diseased kidney in infection, tumor, or non-functionality cases

Advancements in Pediatric Nephrology

Several advances have been made in pediatric nephrology, collectively in diagnosis, treatment, and understanding of various kidney diseases. Some of these advances include:

• Genetic studies for a better understanding of the genetic basis for kidney diseases
• Tailored treatments based on genetics and disease characteristics
• Improved drugs for conditions like nephrotic syndrome
• Safer and accurate minimally invasive procedures for kidney biopsies
• Enhanced options, like home-based dialysis
• Better kidney matching, immunosuppression, and emphasis on living donors
• Remote consultations and follow-ups with telemedicine
• Research into rare diseases
• Patient-centered care

Pediatric nephrology is a dynamic and evolving field pivotal in caring for children with kidney disorders. Through ongoing research, technological innovations, and collaborative efforts, pediatric nephrologists strive to improve diagnostic accuracy, optimize treatment outcomes, and enhance the quality of life for young patients. Fortis continues to offer hope and healing to children and families affected by kidney diseases by addressing current challenges and embracing future opportunities in pediatric nephrology.