What are kidney/urinary problems?
-
Urinary problems may include the kidneys, bladder, or ureters.
-
The kidneys are 2 fist-sized organs in the back of the abdomen that are responsible for filtering the blood and removing waste products.
-
Ureters are tubes that carry the urine from the kidneys to the bladder.
-
The bladder sits right above the pubic bone and collects the urine.
-
-
This Quick Reference Sheet will provide information on nephrotic syndrome, nephritis (glomerulonephritis), and recurrent urinary tract infections (UTIs).
-
Nephrotic syndrome and nephritis (glomerulonephritis) are kidney problems.
-
Recurrent UTIs affect the bladder, but the ureters or kidneys may also be involved.
-
-
Occasionally, children will have renal (kidney) failure and may need to get some form of dialysis.
-
Dialysis is a procedure that removes waste products from the blood.
-
Dialysis can occur through the blood or abdomen.
-
Who is the treatment team?
-
In general, kidney and urinary problems are handled in the child’s medical home.
-
If subspecialty consultation is required, it is usually provided by a pediatric nephrologist or pediatric urologist.
-
Surgery of the urinary system is usually performed by a pediatric urologist.
What are some resources?
-
National Kidney and Urologic Diseases Information Clearinghouse,nkudic@info.niddk.nih.gov
-
National Kidney Foundation,www.kidney.org
Nephrotic Syndrome
What is nephrotic syndrome?
-
Nephrotic syndrome is caused when protein leaks through the membranes in the kidney.
-
Without the protein, fluid escapes out of the blood vessels and into the body tissue, which causes swelling, especially of the legs, abdomen, and face.
-
There can be dramatic weight gain from the water and the child may urinate less.
-
The cause is unknown.
-
There are several types of nephrotic syndrome, but the most common in childhood is minimal change disease. The outlook for children with minimal change disease is quite good, and the vast majority of children recover from minimal change nephrotic syndrome without any permanent kidney damage.
What are some characteristics of children with nephrotic syndrome?
Nephrotic syndrome can occur at any age but is most common between the ages of 18 months and 8 years. Boys are affected more often than girls. A child may come to the child care or school with the diagnosis or may develop it while enrolled.
What adaptations may be needed?
Medications
-
Treatment often starts with steroids.
-
If the nephrotic syndrome is controlled with steroids, they should be slowly discontinued.
-
Steroids may need to be given again if there is a relapse. Sometimes the disease comes back when the steroids are tapered and different medications may need to be considered.
-
Side effects from steroids may include mood swings, increased appetite, and weight gain (which can be hard to sort out from the fluid weight).
-
Over a longer period, steroids can suppress the immune system and make the child more vulnerable to infection.
-
-
Diuretics (fluid pills) are also used to decrease the amount of fluid in the body. Because of the recurrent nature of this condition and the need to repeatedly alter steroid dosages or add additional medications, these children are often referred to a pediatric nephrologist.
-
While the disease is active, the immune system is weakened for 2 reasons.
-
First, the body is not making proteins and is also losing proteins, which help to fight infection
-
Second, steroids can also suppress the immune system.
-
It is important for the child to avoid exposure to chickenpox and measles at those times.
-
-
Because nephrotic syndrome can come and go, at times it is necessary to check the urine for protein. This is done with a urine dipstick that changes colors if dipped in urine that contains protein. The Care Plan should specify if this is necessary.
-
All over-the-counter medications should be approved by the child’s health care professional and specified in the Care Plan.
-
Note on vaccinations: Some changes in the vaccine schedule may need to be made because of nephrotic syndrome or the medications used to treat it. The child should have a medical note explaining any necessary changes.
-
It is critical that children with kidney disease be immunized as fully as possible to protect them against any vaccine-preventable diseases.
-
All children should be vaccinated, especially against influenza, but it is particularly important for those with kidney disease.
-
Dietary considerations
-
To prevent swelling and discomfort, a low-salt diet is a vital part of the care of these children.
-
Foods containing caffeine such as chocolate, tea, and coffee should be avoided if high blood pressure is part of the condition.
What should be considered an emergency?
Check with the child’s Care Plan. Emergencies include
-
Fever. Because the child’s immune system might not be functioning properly, fever can be a serious symptom. -
Increased swelling. This might signal worsening of the disease.-
Blood clots. Isolated swelling, color change, or pain in a limb may be a symptom of a blood clot. -
Abdominal pain or swelling of the abdomen.
-
What types of training or policies are advised?
-
Recognizing symptoms of worsening disease or complication
-
Urine testing if that is a part of the child’s Care Plan
-
Dietary changes
Nephritis (Glomerulonephritis)
What is nephritis (glomerulonephritis)?
-
This kidney condition is similar to nephrotic syndrome except the kidneys lose blood and protein in the urine.
-
Nephritis can be acute or chronic.
-
The acute form frequently occurs after a strep throat infection. While acute glomerulonephritis usually resolves, there can be complications during the acute phase, and these children should be under the close supervision of their health care professional.
-
The chronic form has more causes and is more problematic.
-
What are some characteristics of children with nephritis (glomerulonephritis)?
-
Children may have swelling and red or brown color of the urine because of blood loss.
-
High blood pressure is more common with this form of kidney disease.
How common is it?
Nephritis (glomerulonephritis) is less common than nephrotic syndrome.
What adaptations may be needed?
Considerations are similar to those listed in nephrotic syndrome. Because there are more different types of nephritis, it is important to have a detailed Care Plan that specifies what the particular child needs.
Recurrent Urinary Tract Infections
What are recurrent urinary tract infections?
-
Children can get a single UTI, but those who get them repeatedly may have a problem called vesicoureteral reflux.
-
With this problem, the urine travels backwards from the bladder toward the kidney. This can cause bacteria to be washed up the urinary tract toward the kidney, where it can do damage. If the urine backs up too far, it may cause swelling of the kidneys or
hydronephrosis. -
Some children are prescribed a low-dose antibiotic to try to prevent UTIs. Often, children outgrow this problem and then stop taking antibiotics.
-
Children are usually born with urinary reflux, but it may take time to diagnose the condition.
-
Other conditions can cause blockage of the flow of urine but are less likely to cause problems that need to be addressed in child care and school. These include ureteralpelvic junction obstruction, ureterocele, and posterior urethral valves, which are often surgically corrected in boys shortly after birth. These conditions will not be addressed in this Quick Reference Sheet.
What are some characteristics of children with recurrent urinary tract infections?
Symptoms of a UTI include
-
Fever
-
Painful urination
-
Blood in the urine
-
Sensation that they have to urinate even when the bladder isn’t full
-
Change in the appearance or smell of the urine
What adaptations may be needed?
Medications
Antibiotic prophylaxis (daily low-dose antibiotics) may be recommended. This can usually be administered by parents at home.
Dietary considerations
Hydration is very important for children with UTIs. Children should drink 8 to 10 glasses of water or other fluid per day.
Physical environment
-
Change diapers frequently in infants and toddlers.
-
Encourage children to use the bathroom every 3 to 4 hours to help wash out the bacteria. Children often get busy with their play and don’t remember to go.
What should be considered an emergency?
High fever in the absence of other signs or symptoms may be caused by a kidney infection. Call parents/guardians immediately.
What types of training or policies are advised?
Recognizing symptoms of a UTI
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.