Workshop Jan 2016 (Bladder augment, BOTOX)
Dec 2014 (STING, Lap Cohen, Lap extra
Live Workshop Apr
2014 (PCNL, Lap, Hypospadias)
Undescended Testis, Hernia, Hydrocele
Hydronephrosis (PUJ) Pyeloplasty, Posterior urethral valves (PUV)
Urinary Tract Infection/ Vesico Ureteric Reflux
Urinary Stones in Children
Bedwetting, Urinary Incontinence, Neuropathic bladder
Paediatric Laparoscopic Surgery (Key Hole Surgery)
Common Paediatric Surgical Problems
Dysplastic Kidney, Wilms Tumor, Emergencies
Pregnancy planning, Anomaly scan, Anomaly prevention
nephrology, chronic kidney disease
Acute Kidney Injury
Single kidney status
Chronic kidney disease (CKD)
Chronic Kidney disease is a term used by doctors to include any
abnormality of the kidneys, even if there is only very slight damage.
‘Chronic’ means a condition that does not get completely better. Some
people think that ‘chronic’ means severe. This is not the case, and
often CKD is only a very slight abnormality in the kidneys.
For acute kidney injury (AKI) see the link on AKI
What are the causes of CKD in children?
Chronic Kidney disease in children can be caused by
birth defects (multicystic
hereditary diseases (Poly cystic kidney disease)|
infection (recurrent pyelonephritis, glomerulonephritis)|
systemic diseases (Lupus - SLE)|
Urine blockage or reflux (posterior urethral valve,
vesico ureteric reflux)|
From birth to age 4, birth defects and hereditary diseases are the
leading causes of kidney failure. Between ages 5 and 14, kidney failure
is most commonly caused by hereditary diseases, nephrotic syndrome, and
systemic diseases. Between ages 15 and 19, diseases that affect the
glomeruli are the leading cause of kidney failure, and hereditary
diseases become less common.1
Measuring kidney function - eGFR
A test called the eGFR (estimated glomerular filtration rate) is used to
measure kidney function. The eGFR is calculated by the laboratory from
the level of a chemical called creatinine in the blood.
A normal eGFR is about 100 ml/min in young adults, so the eGFR is
sometimes referred to as the percentage of normal kidney function, as
the number is the same.
Some young adults with normal kidneys will have an eGFR as low as 75
ml/min, and this falls by about 1 ml/min per year as people get older,
so many healthy people aged 75 will have an eGFR of 50-60 ml/min.
Most laboratories now report eGFR alongside their measurements of blood
creatinine levels and this is the most reliable way to obtain an eGFR
result. However, different laboratories use different methods to measure
serum creatinine, and each of these methods gives slightly different
What are the stages of CKD?
is divided into 5 stages:-
1 is eGFR greater
than 90 mls/min, with some sign of kidney damage on other tests (if
all the other kidney tests are normal, there is no CKD).|
2 is eGFR 60-90
with some sign of kidney damage (if all the kidney tests are normal,
there is no CKD).|
3a is eGFR 45-59
ml/min, a moderate reduction in kidney function|
3b is eGFR 30-44
ml/min, a moderate reduction in kidney function|
4 is eGFR 15-29
ml/min, a severe reduction in kidney function|
5 is e GFR less
than 15 ml/min, established kidney failure, when dialysis or a kidney
transplant may be needed.|
Leakage of protein into the urine increases the risk of any kidney
disease. Everyone with CKD should therefore have a urine test to measure
the amount of protein in the urine, and if this level is high, they will
receive more careful treatment and possibly more extensive
How is kidney disease in children diagnosed?
A health care provider diagnoses kidney disease in children by
completing a physical exam, asking for a medical history, and reviewing
signs and symptoms. To confirm diagnosis, the health care provider may
order one or more of the following tests:
Dipstick test for albumin. The
presence of albumin in urine is a sign that the kidneys may be damaged.
Albumin in urine can be detected with a dipstick test performed on a
urine sample. The urine sample is collected in a special container in a
health care provider’s office or a commercial facility and can be tested
in the same location or sent to a lab for analysis. With a dipstick
test, a nurse or technician places a strip of chemically treated paper,
called a dipstick, into the person’s urine sample. Patches on the
dipstick change color when albumin is present in urine.
Urine albumin-to-creatinine ratio. A
more precise measurement, such as a urine albumin-to-creatinine ratio,
may be necessary to confirm kidney disease. Unlike a dipstick test for
albumin, a urine albumin-to-creatinine ratio—the ratio between the
amount of albumin and the amount of creatinine in urine—is not affected
by variation in urine concentration.
Blood test. Blood
drawn in a health care provider’s office and sent to a lab for analysis
can be tested to estimate how much blood the kidneys filter each minute,
called the estimated glomerular filtration rate or eGFR.
Imaging studies. Imaging
studies provide pictures of the kidneys. The pictures help the health
care provider see the size and shape of the kidneys and identify any
Kidney biopsy. Kidney
biopsy is a procedure that involves taking a small piece of kidney
tissue for examination with a microscope. Biopsy results show the cause
of the kidney disease and extent of damage to the kidneys.
How is CKD managed in children?
Treatment for kidney disease in children depends on the cause of the
illness. A child may be referred to a pediatric nephrologist—a doctor
who specializes in treating kidney diseases and kidney failure in
Children with a kidney disease that is causing high blood pressure may
need to take medications to lower their blood pressure. Improving blood
pressure can significantly slow the progression of kidney disease. The
health care provider may prescribe
|angiotensin-converting enzyme (ACE)
inhibitors, which help relax blood vessels and make it easier for the
heart to pump blood|
|angiotensin receptor blockers (ARBs), which help relax blood
vessels and make it easier for the heart to pump blood|
|diuretics, medications that increase urine output|
As kidney function declines, children may need treatment for anemia and
growth failure. Anemia is treated with a hormone called erythropoietin,
which stimulates the bone marrow to produce red blood cells. Children
with growth failure may need to make dietary changes and take food
supplements or growth hormone injections.
Children with renal agenesis or renal dysplasia should be monitored for
signs of kidney damage. Treatment is not needed unless damage to the
kidney occurs. Those with single kidney status (absent by birth/ removed
due to non functioning/ multi cystic dysplastic kidney) should avoid
medications that could damage their kidneys like - NSAID (Ibuprofen,
diclofenac). Aminoglycosides (gentamicin/amikacin) may need careful
monitoring of dose and levels to prevent damage to the only kidney
functioning. Several native medications (siddha, ayurveda etc) may have
multiple ingredients that could potentially damage the kidney and are
Children with PKD tend to have frequent urinary tract infections, which
are treated with bacteria-fighting medications called antibiotics. PKD
cannot be cured, so children with the condition receive treatment to
slow the progression of kidney disease and treat the complications of
Alport syndrome also has no cure. Children with the condition receive
treatment to slow disease progression and treat complications until the
Treatment for hemolytic uremic syndrome includes maintaining normal salt
and fluid levels in the body to ease symptoms and prevent further
problems. A child may need a transfusion of red blood cells delivered
through an intravenous (IV) tube. Some children may need dialysis for a
short time to take over the work the kidneys usually do. Most children
recover completely with no long-term consequences.
Children with post-streptococcal glomerulonephritis may be treated with
antibiotics to destroy any bacteria that remain in the body and with
medications to control swelling and high blood pressure. They may also
need dialysis for a short period of time.
Nephrotic syndrome due to minimal change disease can often be
successfully treated with corticosteroids. Corticosteroids decrease
swelling and reduce the activity of the immune system. The dosage of the
medication is decreased over time. Relapses are common; however, they
usually respond to treatment. Corticosteroids are less effective in
treating nephrotic syndrome due to focal segmental glomerulosclerosis or
membranoproliferative glomerulonephritis. Children with these conditions
may be given other immunosuppressive medications in addition to
corticosteroids. Immunosuppressive medications prevent the body from
Lupus nephritis is treated with corticosteroids and other
immunosuppressive medications. A child with lupus nephritis may also be
treated with blood pressure-lowering medications. In many cases,
treatment is effective in completely or partially controlling lupus
Diabetic kidney disease usually takes many years to develop. Children
with diabetes can prevent or slow the progression of diabetic kidney
disease by taking medications to control high blood pressure and
maintaining normal blood glucose levels.
Urine Blockage and Reflux
Treatment for urine blockage depends on the cause and severity of the
What is the treatment for CKD?
Eating, Diet, and Nutrition
For children with CKD, learning about nutrition is vital because their
diet can affect how well their kidneys work. Parents or guardians should
always consult with their child’s health care team before making any
dietary changes. Staying healthy with CKD requires paying close
attention to the following elements of a diet:
with CKD should eat enough protein for growth while limiting high
protein intake. Too much protein can put an extra burden on the
kidneys and cause kidney function to decline faster. Protein needs
increase when a child is on dialysis because the dialysis process
removes protein from the child’s blood. The health care team
recommends the amount of protein needed for the child. Foods with
protein include: eggs, milk, cheese, chicken, fish, red meats, beans, yogurt, cottage cheese|
amount of sodium children need depends on the stage of their kidney
disease, their age, and sometimes other factors. The health care team
may recommend limiting or adding sodium and salt to the diet. Foods
high in sodium include: canned foods,some frozen foods, most processed foods, some snack foods, such as chips and crackers|
levels need to stay in the normal range for children with CKD, because
too little or too much potassium can cause heart and muscle problems.
Children may need to stay away from some fruits and vegetables or
reduce the number of servings and portion sizes to make sure they do
not take in too much potassium. The health care team recommends the
amount of potassium a child needs. Low-potassium fruits and vegetables
include: apples, cranberries, strawberries, blueberries, raspberries, pineapple, cabbage, boiled cauliflower, mustard greens, uncooked broccoli|
|High-potassium fruits and vegetables include: oranges, melons, apricots, bananas, potatoes, tomatoes, sweet potatoes, cooked spinach, cooked broccoli|
with CKD need to control the level of phosphorus in their blood
because too much phosphorus pulls calcium from the bones, making them
weaker and more likely to break. Too much phosphorus also can cause
itchy skin and red eyes. As CKD progresses, a child may need to take a
phosphate binder with meals to lower the concentration of phosphorus
in the blood. Phosphorus is found in high-protein foods. Foods with
low levels of phosphorus include: liquid nondairy creamer, green beans, popcorn, unprocessed meats from a butcher, lemon-lime soda, root beer, powdered iced tea and lemonade mixes, rice and corn cereals, egg white, sorbet|
in CKD, a child’s damaged kidneys may produce either too much or too
little urine, which can lead to swelling or dehydration. As CKD
progresses, children may need to limit fluid intake. The health care
provider will tell the child and parents or guardians the goal for
Treatment for CKD stages 1 and 2
The blood pressure should be treated carefully. If it is high for the
age, tablets are usually needed, and the aim is to get the blood
pressure down to normal. A blood test to check eGFR should be
performed once a year. If the urine tests show a lot of protein in the
urine, or the kidney function is declining over time, the case will be
discussed with a kidney specialist, or a referral may be made to a
Treatment for CKD stage 3a and 3b
Treatment as in CKD stages 1 and 2, but with more careful monitoring for
declining kidney function. Often at this stage medications are added to
improve haemoglobin (iron supplements) treat acidosis (sodium
bicarbonate) and treat calcium deficiency (calcium supplements).
Medication (ACE inhibitors) may be added to control BP and minimise
protein loss in urine.
Treatment for CKD stages 4 and 5
Any medications should be reviewed, as the dose may need to be altered
and some drugs may need to be avoided as they could damage the kidneys
further. This should include prescribed drugs and any drugs bought at
the chemist and complementary therapies. In CKD stages 4 and 5 it is
usually necessary to get advice from a kidney specialist, especially in
Dialysis and Kidney Transplant
What Is Dialysis?
When someone's kidneys can no longer do their job, beyond stage 5 CKD and can't
get better, a person has End Stage Renal Disease (ESRD) and the doctor might say the
kidneys are failing. This means they are not working well and the person may
need help. The person may be losing weight or feeling tired and sick.
A medical treatment called dialysis (say: dye-AL-ih-sis) can take over the job
of filtering your blood. Through dialysis, a person is hooked up to an
artificial filtering system that removes waste from the blood.
How Does Dialysis Work?
There are two dialysis methods: hemodialysis and peritoneal dialysis.
Hemodialysis uses a
filtering machine to remove waste and extra fluid from the blood.
the actual filtering is done by the lining (peritoneum) of the person's belly! Kids who need
dialysis are most likely to get this type.
With hemodialysis, the person's blood travels through tubes to the machine —
called a dialyzer — which removes extra fluids and waste. Once the blood is
cleaned, the machine sends it back to the person through another tube. This
process typically takes about 4 hours and has to be done three times each week
in a dialysis clinic. A central venous line may be inserted in the neck for
temporary hemodialysis. Those who need long term haemodialysis may be advised to
undergo a minor surgery called AV fistula, which makes it easy for dialysis each
The most commonly used type of peritoneal dialysis for kids, called continuous
cyclic dialysis, uses a machine to put a cleansing solution called dialysate
in the person's belly, usually eight to 12 times each night. As blood flows
naturally through the blood vessels in the belly, extra fluid and waste products
in the blood seep out into the dialysate in the belly. Meanwhile, the dialysate
cleanses the blood and rebalances the blood's chemistry. After about an hour,
the machine drains the dialysate from the belly. A procedure called PD catheter
insertion may be required to facilitate peritoneal dialysis.
Some kids can sleep through dialysis. Others might find it uncomfortable and
inconvenient, so a different type of peritoneal dialysis might be used. The good
news is that afterward, body fluid levels are balanced and waste is gone.
Other Options: Kidney Transplantation
In some cases, a kid can get a new kidney. This is called a
transplant, which means receiving an organ from another person's body.
This operation can be a big help to kids with kidney disease because after the
surgery they may no longer need dialysis treatments.
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