A child’s kidney health is less discussed and often left neglected. However, medical reports suggest a surge in cases concerned with paediatric urology. Noted urologist Dr Ashwin Shekar P talks about taking care of renal health in infancy and more
If you start early and young, you can benefit in the long run. The way it’s important to look after the health of the heart, lungs, stomach, liver, and intestines, similarly, kidneys are vital organs in the abdomen to be taken care of and checked from time to time. With changing lifestyles, it is essential to keep a close watch on children’s kidney condition.
Key organs
A pair of kidneys eliminates waste substances and excess water from the blood through urine and helps balance the composition of crucial chemicals (sodium, potassium and calcium) inside the body. The organs also produce hormones to regulate blood pressure and stimulate the bone marrow to create red blood cells that contain the protein called haemoglobin and transmit oxygen from the lungs to the remaining body parts.
Certain urological complications can affect even children. A child can be at maximum risk of suffering from a condition of paediatric urology at a tender age.
Inborn disorders
“Most paediatric urologic conditions are congenital in nature, meaning the particular problem persists since birth. In other words, children are born with such abnormalities. Some common issues in kids include congenital hernia, swelling of kidney (hydronephrosis due to blockage of kidney or reflux of urine back into the kidney from the bladder), absent testicles in the genitalia or anorchism, abnormality in external genitalia like phimosis wherein the foreskin is not retractable in boys or an abnormally located urethral opening called hypospadias, a congenital disorder in which the opening of the urethra is on the underside of the penis in male infants. The affecting condition may range from mild to severe,” elaborates Dr Ashwin Shekar P, senior consultant paediatric urologist at the Asian Institute of Nephrology and Urology in Hyderabad.
The doctor further ascertains that some conditions can also develop later in life while the child grows. For instance, kidney stones, are a condition that is mostly seen in older children like teenagers. However, such cases are not uncommon in younger infants either.
Building new bladder
Reconstructive bladder surgery may be required when the bladder is either not formed well at birth as in exstrophy bladder (a rare birth defect in which the bladder develops outside the body) or damaged at birth due to a neurogenic spinal lesion. Sometimes, the bladder can be damaged due to long-standing obstructions like a urethral valve that also necessitates reconstructive surgery.
“In such situations, surgery is needed to increase the size of the bladder and decrease the pressure within the bladder so that kidneys are secure from undue damage. The surgical procedure is usually done in open manner but of late, the trailblazing minimally invasive options are also available for children,” he informs.
End-Stage Renal Status
Children’s kidneys could be vulnerable to kidney failure. End-stage renal disease (ESRD) is a permanent condition wherein the kidneys are no longer active. This stage is also dubbed kidney malfunction.
“What we call end-stage renal disease (ESRD) is a situation where both kidneys are damaged to the extent that the body is no longer able to excrete the waste products voluntarily, thereby leading to an increase in urea content as well as creatinine and thus imposing the need for dialysis,” enlightens the urologist.
Many children with paediatric urologic inconsistencies are born with already damaged and abnormal kidneys, thus exposing them to kidney failure quite early in life. In most cases, timely intervention and therapy with a proper follow-up can help evade reaching an end stage, which is usually the last leg of a progressive disease.
Urinary Incontinence
Like adults, children too encounter the issue of involuntary leakage of urine. While it might be just a symptom of an overactive bladder among most minor patients, in some, it could be a sign of a more critical disorder like an abnormal bladder, which may bear serious consequences on kidney function.
“A more common practical symptom is bedwetting, medically called nocturnal enuresis, wherein the children who are otherwise continent while awake, involuntarily release the bladder of urine when in deep sleep,” reports Dr. Ashwin.
A disciplined lifestyle & diet
A well-maintained routine lifestyle, regular diet, physical exercises and medication may help sustain a child’s kidney function properly.
When it comes to lifestyle measures in children with paediatric urologic issues, a few things need to be emphasised:
Having a proper balanced diet and nutrition is important. Malnourishment in early childhood is one of the leading causes of bladder stones among children in developing countries like India. Children should have a balanced diet with lots of fruits and vegetables and limit the consumption of salt and processed foods. Proper hydration is another important aspect when it comes to diet as decreased water intake can increase the risk of stone formation.
It is paramount that children with urinary infection should ward off constipation issues. This is often not given due importance as constipation poses a big risk for recurrent urinary infections in kids.
Symptoms of the disease:
A host of symptoms should alert a parent to the development of a urological disease in their offspring. Fever, abdominal pain (especially on the sides), difficulty or strain in passing urine, crying while urinating, cloudy or foul-smelling urine, involuntary leakage of urine in the daytime or at night or during both periods of the day.
Though a rare sign, blood in urine can also be a determining indication.
Causes
In most cases, urological problems in children are an inborn matter, while some paediatric diseases can run in the family too because of a genetic history.
Post-operative care
In major bladder reconstruction (cystectomy), recovery from surgery usually takes around five to seven days.
Catheters may be kept for around two-three weeks. Post-operation, the bladder should be properly emptied and this is something that the parents are counselled even before the surgery takes place. As the reconstructed bladder cannot discharge the urine on its own, it needs to be drained completely in a timely fashion, lest complications may arise due to accumulated urine.
