Joe DiMaggio Children's Hospital

Edema

Generally speaking, edema refers to the swelling of tissues as a result of excessive fluid retention. Edema can occur in various parts of the body, but it commonly occurs in children around the eyes and in the lower legs. Patients with kidney problems and/or heart problems may be especially prone to edema.

Electrolyte Abnormalities

Electrolytes are ions that conduct electricity within the human body to help cells and organs maintain healthy functioning. When electrolytes are deficient or overabundant, a patient's health can be compromised.

Because kidneys play a major role in determining the amount of electrolytes that are excreted in urine, nephrologists are trained to diagnose and treat symptoms that cause, or are caused by, electrolyte imbalances.

Glomerulonephritis

Glomerulonephritis is a type of kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged. Glomerulonephritis may be caused by specific problems with the body's immune system. Often, the precise cause of glomerulonephritis is unknown.

Damage to the glomeruli causes blood and protein to be lost in the urine. The condition may develop quickly, with loss of kidney function occurring over weeks and months (called rapidly progressive glomerulonephritis).

Hematuria

Hematuria is defined as the presence of red cells in the urine. There are some pigments that can falsely detect blood in the urine, but the conditions are not related to kidney diseases. Hematuria can be microscopic or visible to the eye (gross hematuria).

Once red cells are identified in the urine, a careful history and physical examination need to be performed, in addition to a kidney and bladder ultrasound, along with blood tests. Urinary tract infections, trauma, medications, nephritis and kidney stones are the most common causes of hematuria.

Hydronephrosis

Hydronephrosis is a condition in which the kidney is full of urine, due to a number of different conditions. Causes of hydronephrosis include structural abnormalities present at birth, vesicoureteral reflux, partial or complete blockage of the urinary tract, kidney stones or acute injury.

Fortunately, hydronephrosis will sometimes clear up on its own. If it does not, surgery can correct the problem.

Hypercalciuria

Hypercalciuria is a condition in which the body excretes an unusually high amount of calcium into the urine. The condition is sometimes accompanied by excessive calcium consumption in the diet, or excess calcium absorption by the intestine.

Hypercalciuria can be treated with medication and/or dietary adjustments. It is important to monitor patients carefully, as hypercalciuria is often a precipitating factor in kidney stones. However, patients should keep a normal calcium intake to prevent bone loss, which is seen in a large percentage of patients with hypercalciuria.

Hypernatremia

Hypernatremia is a condition in which the amount of sodium in the blood is abnormally high. As an example, an acute form of hypernatremia may be caused by inadequate fluid intake or by a sudden and dramatic loss of fluid (almost exclusively water), as from diarrhea or vomiting. Chronic hypernatremia may be the result of kidney disease.

Hypernatremia is treated by oral or intravenous administration of water. However, great care must be taken not to administer too much water in a short period of time, as the sudden intake of water could result in cellular damage.

Hyperpotassemia (also called hyperkalemia)

Hyperpotassemia is a condition in which the amount of potassium in the blood is abnormally high. The most common cause of hyperpotassemia is kidney disease. Other causes of hyperpotassemia include Addison's disease, acidosis, burns or other acute injuries to muscle, and the excessive consumption of a potassium salt.

In an emergency situation, hyperpotassemia can be treated with injections of insulin and glucose, or dialysis. In nonemergent situations, a low-potassium diet is recommended. A medication containing a special resin can also be prescribed.

Hypertension

Hypertension is defined as persistently elevated blood pressure for age, gender and height. Symptoms can be absent, or patients can experience seizures, headaches, visual disturbances, chest pain, palpitations or vague fatigue.

Evaluation of both heart and kidneys, along with blood and urine tests, need to be performed to identify a secondary cause, common in children. However, the majority of adults have essential hypertension (without identifiable cause). Treatment includes lifestyle changes (diet and exercise) and/or medications.

Hyponatremia

Hyponatremia is an unusually low concentration of sodium in the blood. In some cases, it is caused by the sudden and excessive consumption of water, which will dilute the concentration of sodium in the body. However, in most cases, it is caused by various conditions that may result in an electrolyte imbalance, such as dehydration, liver disease, kidney disease, endocrine problems, and low-sodium diet.

Hyponatremia is treated according to the underlying cause. As for the actual sodium deficiency, it can be remedied with an intravenous infusion of a sodium-containing solution, if oral consumption is not possible.

Hypopotassemia (also called hypokalemia)

Hypopotassemia is a condition in which the amount of potassium in the blood is abnormally low. Some causes of hypopotassemia include kidney disorders, adrenal disorders, alkalosis, and insufficient dietary intake of potassium or magnesium. Certain medications may also contribute to potassium loss.

Hypopotassemia is treated according to the underlying cause. If necessary, a physician can prescribe oral or intravenous potassium supplements or special diuretics that encourage urination but do not deplete the body of potassium.

Kidney Stones

A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time. Kidney stones can form when urine composition is altered.

Kidney stones may not produce symptoms until they begin to move down the tubes (ureters) through which urine empties into the bladder. When this happens, the stones can block the flow of urine out of the kidneys. This causes swelling of the kidney or kidneys, causing pain, usually severe.

Kidney stones are common. A person who has had kidney stones often gets them again in the future. Kidney stones can also occur in premature infants.

Kidney Transplant

Kidney transplants are one of the most common transplant operations in the United States. One donated kidney is needed to replace the work previously done by two kidneys.

The donated kidney may be from:

• Living related donor – related to the recipient, such as a parent, sibling, or child
• Living unrelated donor -- such as a friend or spouse
• Deceased donor – a person who has recently died and who has no known chronic kidney disease

The healthy kidney is transported in a cool solution that preserves the organ for up to 48 hours. This gives the health care providers time to perform tests that match the donor's and recipient's blood and tissue before the operation.

Lupus

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder. SLE may affect the skin, joints, kidneys, and other organs. Normally, the immune system helps protect the body from harmful substances, but in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. The result is an overactive immune response that attacks otherwise healthy cells and tissue. This leads to long-term (chronic) inflammation.

The underlying cause of autoimmune diseases is not fully known. SLE affects nine times as many women as men. It may occur at any age, but appears most often in people between the ages of 10 and 50. African Americans and Asians are affected more often than people from other races.

Metabolic Bone Disease and Mineral Metabolism

Metabolic Bone Disease consists of a group of disorders that have in common bone abnormalities ranging from change in shape of the bone, to fractures. Blood tests and bone scans need to be performed to establish the cause, as well as evaluate the appropriate therapy. The two most important minerals involved in bone health are calcium and phosphorus, and abnormalities in their metabolism are carefully assessed in our program.

Evaluation and treatment of bone disorders and mineral abnormalities are important to assure normal growth and development in infants and children.

Nephritis

Nephritis is the general term for kidney inflammation. There are many different forms of nephritis. Two examples are:

• Pyelonephritis, inflammation caused by a urinary tract infection that has reached the kidney(s)
• Glomerulonephritis, the inflammation of the glomeruli, which are tiny structures inside the kidneys that are crucial to blood filtration

Treatment for glomerulonephritis largely depends on the underlying cause. A kidney biopsy may be necessary for establishing the diagnosis. Antibiotics, diuretics and anti-hypertensives are some of the medications that may be prescribed. Occasionally, steroids and chemotherapy drugs are necessary to preserve the kidney function. Rarely though, renal failure develops and patients may need dialysis and/or transplantation.

Nephrotic Syndrome

Nephrotic syndrome is a group of symptoms including protein in the urine, low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling (edema).

Nephrotic syndrome is caused by various disorders that affect the basement membrane of the glomerulus. This immediately causes abnormal loss of protein in the urine. Nephrotic syndrome can affect all age groups. In children, it is most common from ages 2 to 6. This disorder occurs slightly more often in males than females.

Proteinuria

Proteinuria is the excessive excretion of protein in the urine. This condition is often associated with nephritis, nephrotic syndrome, diabetes and hypertension.

Treatment for proteinuria will depend on the underlying cause. Some patients may also be advised to restrict their intake of salt.

Renal Failure (also known as Kidney Insufficiency)

Acute kidney failure is the sudden loss of the ability of the kidneys to remove waste, associated with water retention and electrolyte imbalances.

There are many possible causes of kidney damage. They include:

• Acute tubular necrosis (ATN)
• Autoimmune kidney disease, including Acute nephritic syndrome and Interstitial nephritis
• Decreased blood flow due to very low blood pressure
• Disorders that cause clotting within the kidney's blood vessels
• Infections that directly injure the kidney
• Urinary tract obstruction

Once the cause is found, the goal of treatment is to restore kidney function and prevent fluid and waste from building up in the body while the kidneys heal. Usually, patients have to be hospitalized for treatment.

Vesicoureteral reflux (VUR)

Under normal circumstances, urine flows down from the kidneys, through tubes called ureters, to the bladder. Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder back into the ureters/kidneys. VUR can (not always) lead to infection because urine that remains in the child's urinary tract provides a place for bacteria to grow. It is most commonly diagnosed in infancy and childhood after the patient has a urinary tract infection and about one-third of children with a urinary tract infection are found to have VUR.

Voiding problems

Voiding problems, under the term dysfunctional voiding, are very common in children and can range from very mild to, rarely, severe problems which cause damage to the kidneys. Both daytime loss of urine and nighttime bedwetting are abnormal situations that need to be evaluated by both pediatric nephrologists and pediatric urologists. They can be caused by abnormal anatomy, neurologic diseases, or behavioral disorders. Specific therapies can be prescribed depending on the cause.

Effective treatment of voiding disorders can improve the emotional well being of the child, and improve the quality of life for the patient and family.

If you would like more information about the Division of Pediatric Nephrology and Hypertension, please call 954-265-9344.