Paediatric kidney and urology disorders

Some common disorders of the kidney affecting children

Blood in urine (hematuria): Many conditions can cause blood to show up in urine, a condition called hematuria. Often these conditions do not lead to lasting problems. But because blood in urine may be a sign of serious kidney problem it needs treatment.

Protein in urine (proteinuria): Proteinuria means that urine contains more protein than usual. Most proteins are too big to go through the kidneys' filters, so too much protein in urine may be a sign of a kidney problem.

Glomerulonephritis: Glomerulonephritis and interstitial nephritis cause swelling and redness (inflammation) in parts of the kidney. This makes it harder for the kidney to separate wastes and extra fluid from the blood. It can cause swelling (edema), blood in the urine, high blood pressure and fatigue. This can sometimes lead to lifelong (chronic) kidney disease.

Nephrotic syndrome: Nephrotic syndrome occurs when large amounts of protein get into the urine, leaving low levels in the blood. Blood proteins act like a sponge, helping water to stay inside your child’s blood vessels. When protein gets into urine, not enough is left in the blood, and water moves into body tissues, causing them to swell.
Genetic kidney disease
Some kidney diseases come from problems with genes or chromosomes that are passed down within families. These genetic diseases include Polycystic Kidney Disease (PKD), in which many fluid-filled cysts develop in the
kidneys and limit how well they function.

High blood pressure (hypertension): While high blood pressure is more common in adults, children and teens can develop the problem too. If untreated, over time high blood pressure can damage many organs of the body, including the heart, brain, kidneys and eyes. The normal range for blood pressure depends on your child's sex, age and height.
Kidney failure, including chronic kidney disease and acute kidney injury: Kidney failure happens when the kidneys can no longer remove all of the wastes from the blood. Kidney failure can either be lifelong (chronic) or sudden (acute). Chronic disease usually develops slowly. Your child may not show any symptoms until the kidneys are not doing their job and can remove only a small amount of waste. Children with acute kidney injury sometimes need dialysis treatments until their kidneys begin to work again.

Urinary tract infection: Urinary tract infection in a child sometimes indicates underlying abnormalities in kidney and urinary tract. Further detail investigation and imaging is sometimes required and preventive measures are needed for recurrent UTI.

Enuresis/incontinence/disorder in micturation: Enuresis means when a child wet bed after 5 years of age. It is a common problem often causing considerable distress to the child and his family. Incontinence means loss of urine without normal emptying of the bladder.

Kidney Swelling
Hydronephrosis: Hydrone-phrosis is the swelling of the kidneys when urine flow is obstructed in any of parts of the urinary tract mainly at ureter junction with kidney or bladder.

Kidney Tumor: A kidney tumor is an abnormal growth within the kidney and it can be presented as a painless mass / lump, pain in flank or blood in urine. Recurrent UTI is another symptom. A tumor may be benign or malignant.
Kidney Stone: A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Symptoms of a kidney stone include flank pain (which can be quite severe) and blood in the urine (hematuria).

Any other congenital Kidney abnormality: Many abnormalities or defect may occur during development of kidney system. The common abnormalities are:
a) Absence of one kidney
b) More than one kidney on one or both sides
c) Horse shoe shaped kidney
d) Ectopic kidney not located at its correct place
e) Cysts in the kidney etc
Kidney Trauma: Severe trauma to the kidney can be occurred at any time with trivial force and may need emergency surgical management by urologist.

Ureter related disease
Hydroureter- dilatation of the ureter due to obstructed outflow.
Narrowing, duplication or any other congenital abnormality like opening outside of urinary bladder or beyond normal site of the bladder.
Vesicoureteric reflux (VUR) is characterized by the retrograde flow of urine from the bladder to the ureters & kidneys.
Ureteric stone- is a mineral mass in the ureter, which may or may not have originated in the kidney and traveled down into the ureter. It can cause severe pain or blood in urine.

Urinary bladder and urethra:
Bladder Extrophy - A congenital anomaly in which part of the urinary bladder is present outside the body due to defective development of anterior abdominal wall and bladder wall.
Bladder Stone - It can cause pain, blood in urine or repeated urinary tract infection.

Bladder Diverticula - These are small, bulging pouches in the bladder wall. Though they often do not produce specific symptoms but may be associated with urinary tract infections, difficulty voiding or abdominal fullness, particularly if they become large and causing the bladder to empty incompletely.

Posterior Urethral Valve (PUV) - Congenital presence of valve like structure in urethra causes difficulty in voiding in a male child which can cause destruction of one or both the kidney.

External Genitalia
Penile and Urethral congenital deformity like curved penis (chordee), Hypospadias/ epispadias ( urine coming from abnormal opening).

Small Buried penis, apparent shortening of penile size especially in obese children.

Absent Testis (Undescended Testis)-is a common childhood condition where a boy is born without having one or both testicles in their scrotum. This condition needs timely surgical intervention to avoid unwanted outcome.

Testicular or Scrotal Pain-Common causes of testicular pain are torsion testis & epididymo-orchitis. Torsion is a urological emergency situation when testicles rotates on the spermatic cord, resulting in cutting off the testicle's blood supply and ultimately destroy the affected testis which needs correction within a very short time. On the other hand epididymo-orchitis is an infl
ammation of the epididymis and/or testis usually caused by virus or bacteria.

Ambiguous Genitalia-'Ambiguous genitalia' or atypical genitalia is a birth defect of the external genitalia that makes it unclear whether an affected newborn is a girl or boy.
Penile Cyst-localized soft swelling over any part of the penis.
Voiding Difficulty-Voiding dysfunction is a common problem in children and accounts for frequent pediatric urology clinic visits. Common symptoms are Incontinence (urine leakage) during the day and/or night, Increase in urinary frequency and/or urgency, Urinary hesitancy, Dribbling, Intermittent urine flow and/or straining at urination, infrequent urination - three or fewer voids in a 24-hour period.

Apart from these, if you find any of the following urological symptoms, you should visit your physician.
Flank swelling or pain
Recurrent Urinary Tract Infection(UTI)
Haematuria (Blood in Urine)
Difficulty in passing urine, dribbling
Empty Scrotum (Absent testis)
Painful Scrotum
Swollen Scrotum
Absence of normal penile opening
Enuresis (Bed wetting).

Source: Apollo Paediatric Kidney and Urology Clinic

 

Paediatric kidney and urology disorders

Some common disorders of the kidney affecting children Blood in urine (hematuria): Many conditions can cause blood to show up in urine, a condition called hematuria. Often these conditions do not lead to lasting problems. But because blood in urine may be a sign of serious kidney problem it needs treatment. Protein in urine (proteinuria): Proteinuria means that urine contains more protein than usual. Most proteins are too big to go through the kidneys filters, so too much protein in urine may be a sign of a kidney problem. Glomerulonephritis: Glomerulonephritis and interstitial nephritis cause swelling and redness (inflammation) in parts of the kidney. This makes it harder for the kidney to separate wastes and extra fluid from the blood. It can cause swelling (edema), blood in the urine, high blood pressure and fatigue. This can sometimes lead to lifelong (chronic) kidney disease. Nephrotic syndrome: Nephrotic syndrome occurs when large amounts of protein get into the urine, leaving low levels in the blood. Blood proteins act like a sponge, helping water to stay inside your childs blood vessels. When protein gets into urine, not enough is left in the blood, and water moves into body tissues, causing them to swell. Genetic kidney disease Some kidney diseases come from problems with genes or chromosomes that are passed down within families. These genetic diseases include Polycystic Kidney Disease (PKD), in which many fluid-filled cysts develop in the kidneys and limit how well they function. High blood pressure (hypertension): While high blood pressure is more common in adults, children and teens can develop the problem too. If untreated, over time high blood pressure can damage many organs of the body, including the heart, brain, kidneys and eyes. The normal range for blood pressure depends on your childs sex, age and height. Kidney failure, including chronic kidney disease and acute kidney injury: Kidney failure happens when the kidneys can no longer remove all of the wastes from the blood. Kidney failure can either be lifelong (chronic) or sudden (acute). Chronic disease usually develops slowly. Your child may not show any symptoms until the kidneys are not doing their job and can remove only a small amount of waste. Children with acute kidney injury sometimes need dialysis treatments until their kidneys begin to work again. Urinary tract infection: Urinary tract infection in a child sometimes indicates underlying abnormalities in kidney and urinary tract. Further detail investigation and imaging is sometimes required and preventive measures are needed for recurrent UTI. Enuresis/incontinence/disorder in micturation: Enuresis means when a child wet bed after 5 years of age. It is a common problem often causing considerable distress to the child and his family. Incontinence means loss of urine without normal emptying of the bladder. Kidney Swelling Hydronephrosis: Hydrone-phrosis is the swelling of the kidneys when urine flow is obstructed in any of parts of the urinary tract mainly at ureter junction with kidney or bladder. Kidney Tumor: A kidney tumor is an abnormal growth within the kidney and it can be presented as a painless mass / lump, pain in flank or blood in urine. Recurrent UTI is another symptom. A tumor may be benign or malignant. Kidney Stone: A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Symptoms of a kidney stone include flank pain (which can be quite severe) and blood in the urine (hematuria). Any other congenital Kidney abnormality: Many abnormalities or defect may occur during development of kidney system. The common abnormalities are: a) Absence of one kidney b) More than one kidney on one or both sides c) Horse shoe shaped kidney d) Ectopic kidney not located at its correct place e) Cysts in the kidney etc Kidney Trauma: Severe trauma to the kidney can be occurred at any time with trivial force and may need emergency surgical management by urologist. Ureter related disease Hydroureter- dilatation of the ureter due to obstructed outflow. Narrowing, duplication or any other congenital abnormality like opening outside of urinary bladder or beyond normal site of the bladder. Vesicoureteric reflux (VUR) is characterized by the retrograde flow of urine from the bladder to the ureters kidneys. Ureteric stone- is a mineral mass in the ureter, which may or may not have originated in the kidney and traveled down into the ureter. It can cause severe pain or blood in urine. Urinary bladder and urethra: Bladder Extrophy - A congenital anomaly in which part of the urinary bladder is present outside the body due to defective development of anterior abdominal wall and bladder wall. Bladder Stone - It can cause pain, blood in urine or repeated urinary tract infection. Bladder Diverticula - These are small, bulging pouches in the bladder wall. Though they often do not produce specific symptoms but may be associated with urinary tract infections, difficulty voiding or abdominal fullness, particularly if they become large and causing the bladder to empty incompletely. Posterior Urethral Valve (PUV) - Congenital presence of valve like structure in urethra causes difficulty in voiding in a male child which can cause destruction of one or both the kidney. External Genitalia Penile and Urethral congenital deformity like curved penis (chordee), Hypospadias/ epispadias ( urine coming from abnormal opening). Small Buried penis, apparent shortening of penile size especially in obese children. Absent Testis (Undescended Testis)-is a common childhood condition where a boy is born without having one or both testicles in their scrotum. This condition needs timely surgical intervention to avoid unwanted outcome. Testicular or Scrotal Pain-Common causes of testicular pain are torsion testis epididymo-orchitis. Torsion is a urological emergency situation when testicles rotates on the spermatic cord, resulting in cutting off the testicles blood supply and ultimately destroy the affected testis which needs correction within a very short time. On the other hand epididymo-orchitis is an infl ammation of the epididymis and/or testis usually caused by virus or bacteria. Ambiguous Genitalia-Ambiguous genitalia or atypical genitalia is a birth defect of the external genitalia that makes it unclear whether an affected newborn is a girl or boy. Penile Cyst-localized soft swelling over any part of the penis. Voiding Difficulty-Voiding dysfunction is a common problem in children and accounts for frequent pediatric urology clinic visits. Common symptoms are Incontinence (urine leakage) during the day and/or night, Increase in urinary frequency and/or urgency, Urinary hesitancy, Dribbling, Intermittent urine flow and/or straining at urination, infrequent urination - three or fewer voids in a 24-hour period. Apart from these, if you find any of the following urological symptoms, you should visit your physician. Flank swelling or pain Recurrent Urinary Tract Infection(UTI) Haematuria (Blood in Urine) Difficulty in passing urine, dribbling Empty Scrotum (Absent testis) Painful Scrotum Swollen Scrotum Absence of normal penile opening Enuresis (Bed wetting). Source: Apollo Paediatric Kidney and Urology Clinic