Kidney diseases can be silent, and a few signs may help parents suspect their child suffers from one. Let’s start with the urine, which on some occasions becomes the “mirror” of the kidneys. Just by looking at the color, transparency, persistent foaming, or sediment (in infants a diaper stain) the parent can suspect a problem and bring it to the attention of their physician, aiding in early diagnosis.
Fever is a late sign of urinary tract infection (UTI), and UTIs can be suspected if urine is cloudy, foul-smelling, or the child has painful and frequent urination. A urine culture is needed to clarify this issue. The skin color, swelling (so-called edema), high blood pressure (hypertension), or a rash along with urine changes, can suggest a kidney problem, which may be sudden in onset (acute), or persistent for a while (chronic). A few examples are nephrotic syndrome (characterized by protein losses in the urine, low blood protein levels and edema of the face and/or ankles) and glomerulonephritis (inflammation of the kidney filtering units, known as the “glomeruli”). It is important to note that the majority of children have a secondary identifiable cause of hypertension, compared to adults.
A few tests are essential in establishing the diagnosis of kidney disease, the most common being the kidney sonogram. It is non-invasive, easy to perform, and gives us a wealth of information, identifying cysts, stones, kidney anomalies (i.e., single kidneys, horseshoe kidneys, etc), and suspect blockage (obstruction), just to name a few. Nuclear scans, tests for reflux, or other complex imaging studies can be ordered later, as the case dictates.
For some glomerular diseases, a more precise diagnosis is necessary, established by examination of the tissue under the microscope (biopsy). The biopsy is performed with ultrasound (more frequently) or CT guidance, under sedation. Aside from maintaining the body composition by excreting some of the “metabolic waste”, kidneys contribute to the production of enzymes (for blood pressure regulation or activation of vitamin D) and hormones (i.e., erythropoietin for maturation of red blood cells). Lack of energy, fatigue, loss of appetite, poor weight gain and short stature may be signs of kidney failure, and blood tests (such as serum creatinine) are needed. Kidney failure affects all these “tasks” in various degrees, and patients may not experience any symptoms until the kidney function is severely reduced. Therefore, awareness of kidney disease has earned its high priority status.
Alex. R. Constantinescu, MD
Medical Director, Pediatric Nephrology and Hypertension
Joe DiMaggio Children’s Hospital
1150 N 35th Ave, Suite 499
Hollywood, FL 33021