Category Archives: Pediatric Issues

My son, now 5 years old was diagnosed with Hydronephrosis in both kidneys before birth. He was monitored for 2 years and was released of urology and nephrologist but the past few weeks he’s showed high blood pressure, very metallic smelling hair and breath. He has been wetting his bed at night and cannot seem to stop sweating and drinking excessive water. Should I get a lab work up?

I suggest that you consult with your son’s pediatrician for an examination.  Laboratory testing may be needed but a good examination by his pediatrician will be important to make sure the proper tests are performed. For more information on children’s … Continue reading

Posted in Ask the Doctor, Bed-Wetting, Birth Defects/Urinary Tract Abnormalities, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues, Pregnancy / Kids, Symptoms and Side Effects, Treatments

Is rituximab safe to treat Nephrotic syndrome in a 12 year old

I am an adult nephrologist and have never used Rituximab (Rituxan) in children.  I suggest that you consult with a pediatric nephrologist. For more information on Children’s health click here:

Posted in Ask the Doctor, Kidney-Related Health Questions, Nephrologist, Pediatric Issues, Pregnancy / Kids, Treatments

Hello, My 9 year old son recently had an renal ultrasound to look for kidney stones, etc. We don’t follow up with the nephrologist for over a month, and I’m curious about ultrasound report. The nurse told me on the phone that he didn’t have kidney stones, and this is what the report actually says: 1. Mild right pelviectasis in the prone position only (7 mm). 2. Otherwise normal sonographic appearance of the kidneys. No definite calcifications are seen. In the prone position only, there is mild right pelviectasis (SFU grade 1 bordering on 2) with AP diameter of the pelvis measuring 7 mm. I assume the pelviectasis isn’t serious since the nurse didn’t bring it up on the phone, but never having heard the term before, I tried to research it. The only references I can find refer to fetal pelviectasis, and I can’t find anything about this condition in a 9 year old child. I’m also curious about it only being seen in the prone position. Does this point to the possibility of some sort of blockage, or is it likely just a physiological finding? Is it unusual in a child his age?

Pelviectasis (also called pelvocaliectasis) merely means a separation of the collecting system or pelvis of the kidney detected by the ultrasound device.  It does not suggest any disease, unless there are symptoms or signs of blockage and none are described. … Continue reading

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Blood/Urine Testing For Kidney Disease, Kidney Stones, Kidney-Related Health Questions, Laboratory Testing, Nephrologist, Pediatric Issues, Pregnancy / Kids

My son is 2.5 years old and we are in Romania. I am American and my husband is British. My son is being treated here for Nephrotic Syndrome but we would like to take him to England or America for further treatment. Do you have advice about traveling by plane. Perhaps you need to know more about his condition but if you have general advice it would still be helpful.

Traveling by airplane should not pose a risk to anyone with nephrotic syndrome.  The long travel time in an airplane with inactivity could result in blood clots in the legs.  Forming blood clots in the legs of patients with chronic … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Kidney-Related Health Questions, Laboratory Testing, Nephrotic Syndrome, Pediatric Issues

I originally posted a question on 1/17/17 about my 9 year old son. I don’t see a way to respond to the reply, but have some more information that might be helpful to others looking for information on the same thing. At his doctor’s request, I was able to scrape some off to take in to the lab, and the stone analysis came back as 65% calcium oxalate dihydrate and 35% carbonate apatite. Additionally, a 24 hour urine test indicated a calcium/creatinine ratio of 245 (normal 30-20-) and an elevated creatinine level of .81 (normal 0.11-0.68). The doctor said for him to follow a low oxalate diet and follow-up with a pediatric nephrologist, which we will. Is it important to find the cause of the high creatinine and calcium rather than just treat the symptom? I remembered that my aunt (would be his great-aunt) died from nephritis at age 7, but don’t know if that would be considered a genetic risk for him that far removed.

I am unable to make any specific diagnosis based on the information that you present.  It is best if you see a pediatric nephrologist and have further testing.  It is possible that he has a genetic kidney stone disease but … Continue reading

Posted in Ask the Doctor, Kidney Stones, Kidney-Related Health Questions, Pediatric Issues, Pregnancy / Kids, Treatments

For the past year, my 9 year old daughter has been getting regular immoglobulin treatments (Gammumex)which are responsible for a miraculous improvement in her mobility, since she has Chronic Inflammatory Demyelating Polyneuropathy. For almost a year she got the treatments at 2 week intervals and more recently at three week intervals. These IVIG treatments, necessary as they are, are hard on the liver and kidneys, but do you know just how toxic these IVIG treatments can be to a child’s kidneys over time? Have you heard of this type of treatment ever damaging the kidneys? She doesn’t get an especially high dose, just average, and her neurologist says any irregular reading on the kidney and liver test we took should be disregarded because that’s just due to the IVIG’s. But because this is a rare disease, most of the frequency/dose of the treatment still involves guesswork and experimentation, so I remain watchful for signs of stress on her body. In the last several months she is getting bladder infections now and then that she didn’t get before. So far they just go away with cranberry juice. Then in the last 6-7 weeks I usually have to push her to eat because she frequently gets stomach pain. She was never a big eater to begin with so I worry about her getting enough protein and losing alot of weight again, which she did when she was initially misdiagnosed, wasn’t getting these treatments, and lost most of her mobility. What scares me most is that I read everywhere about how there are no symptoms of kidney disease until it’s advanced. So should I be proactive/concerned, then? If you say yes, my next step would be to show the readings we have to pediatric kidney doctor in our hospital system, to see if a more detailed kidney/liver test should be taken The test the neurologist ordered wasn’t, I was told, but that’s because her neurologist is unconcerned. The reason I feel the need to check with a third party at times is because he was the one who misdiagnosed her, so I had to go to another doctor and then go back and convince him to give her these IVIG treatments, which I think saved her life.

I would recommend blood and urine testing for kidney disease at least every three months to monitor kidney function.  This should include a serum creatinine and an estimated glomerular filtration rate (eGFR).  Urine testing should be for blood, protein and … Continue reading

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Diet/Nutrition, GFR, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues, Pregnancy / Kids, Symptoms and Side Effects, Treatments

My 9 year old son has had a very bright white, chalk-like residue in his underwear for several months. It is usually dried when I find it, and when I flake it off, it becomes powdery. It is definitely not a “discharge” from infection or seminal fluid. When I first saw it I thought it was paint, or white-out. When I examined it my first thought was that it looked like calcium (Tums) or some sort of mineral. He has had this once every week or so for 4-5 months, and I am now noticing that on days when he has it he often has an episode of stomach pain, which he describes as hurting fairly badly. He has never before complained of stomach pain so this made me pay attention and I noticed the correlation. It has not been accompanied by any pain or burning with urination until just the other day. That day he called me in to the bathroom to see a white, wet but powdery discharge, almost like wet chalk clumps. It was on his penis as well, and that time he said the opening in his penis hurt when he urinated. I was able to scrape a bit of the substance, which is like a hard flake, though very small. His doctor is having me take it to the lab to be tested. I’m curious if you’ve every heard of something like this, and what it might indicate? He is not dehydrated, and his urine is almost always a light straw color. Incidentally, the last week or so he has been waking with mildly to moderately puffy eyes.

I am unable to provide a specific diagnosis based on the information that you describe.  This is a finding that I have never seen before.  I suggest that you continue to work with your pediatrician and seek consultation based on … Continue reading

Posted in Ask the Doctor, Birth Defects/Urinary Tract Abnormalities, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues, Pregnancy / Kids, Symptoms and Side Effects

My 8 month old daughter started peritoneal dialysis 2 months ago. What does she feel like? What are some basics that her nephrologist should be doing? She has cysts on both of her kidneys. Any advice would be greatly appreciated. We do labs every 2 weeks now. She doesn’t urinate anymore. Her medications include – kayexalte, sodium chloride, iron, vitamin d, calcium carb, calcitriol. She also has low muscle tone and a gtube.

I am an adult nephrologist and do not see children.  I have no experience with young infants on peritoneal dialysis.  I suggest that you consult with a pediatric nephrologist for answers to your questions.  

Posted in Ask the Doctor, Dialysis, Kidney Failure, Kidney-Related Health Questions, Pediatric Issues, Treatments

My 16 yr old very athletic son suddenly developed HTN 5 weeks ago, along with pulse in 90’s-114 at rest. This was accompanied with intermittent upper mid abdominal pain. After evaluation by a cardiologist, gastro and nephrologist, nothing determined as the cause. His labs showed high Hgb and a 24 hr urine collection showed creatinine of 3402 mg/dl, as well as high norepinephrine and low dopamine. He still has the abdominal pain even though he has been taking a blood pressure med for 3 nights now. He only had 1000ml of urine in 24 hrs (because we had to dump the first specimen) but this does not seem like enough for a 5’11” 180 lbs guy. He does not feel the need to urinate when he wakes up in the morning. I’m scared he has a kidney problem. What tests should be done?

I suggest further testing for an endocrine cause of the hypertension.  Your son may need to be seen by an endocrinologist.   I would also make sure that he is not taking any body building supplements that might cause these … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Hypertension/High Blood Pressure, Kidney-Related Health Questions, Laboratory Testing, Pediatric Issues, Pregnancy / Kids, Symptoms and Side Effects, Treatments

Hello, my daughter is 17 months old. In her KFT Creatinine is .22 mg/dL and Blood Urea Nitrogen is 14 mg/dL but BUN/Creat Ratio is 63.64. What does it mean? I am worried about it.

We do not use the Blood Urea Nitrogen (BUN) to Creatinine (Creat) ratio to make any diagnosis.  It is of no consequence.  If the BUN and Creatinine are normal, nothing needs to be done.

Posted in Ask the Doctor, Pediatric Issues, Pregnancy / Kids