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Pediatric Nephrologist
Pediatric nephrologists diagnose, treat, and manage many
disorders affecting the kidney and urinary tract, including kidney
failure, high blood pressure, inherited kidney diseases, kidney stones,
urinary tract infections, and abnormalities in the urine such as blood
and protein.
If your child has kidney or urinary tract disease, bladder problems,
kidney stones, or high blood pressure, a pediatric nephrologists has
the special skills and experience to treat your child. Pediatric
nephrologists treat children from infancy through late adolescence
and in some centers up to young adulthood.
Nephrology is a specialty of medicine and pediatrics that concerns
itself with the study of normal kidney function, kidney problems, the
treatment of kidney problems and renal replacement therapy (dialysis
and kidney transplantation).
Pediatrics is the branch of medicine that deals with the medical care
of infants, children, and adolescents, and the age limit usually ranges
from birth up to 18 years of age (in some places until completion of
secondary education, and until age 21 in the United States).

What Types of Treatments Do Pediatric Nephrologists Provide?

Pediatric nephrologists diagnose, treat, and

manage many disorders affecting the kidney and
urinary tract, including kidney failure, high blood
pressure, inherited kidney diseases, kidney stones,
urinary tract infections, and abnormalities in the
urine such as blood and protein. They also know
how to evaluate and treat problems with growth
and development that are specifically related to
chronic kidney disease. They are also skilled in
helping patients transition from pediatric
nephrologists to nephrologists and urologists that
care for adult patients.

Pediatric nephrologists generally

provide the following services:

Dialysis
Kidney transplantation
Kidney biopsies
The interpretation of x-ray studies of the kidney
The interpretation of laboratory studies related to kidney
disease
Ambulatory blood pressure monitoring
Pediatric nephrologists are the coordinators of a team
that includes specialized nurses, dieticians, and social
workers, all dedicated to the care of children with kidney
diseases. They work closely with other physicians such as
pediatric urologists, pediatric surgeons, and pediatric
radiologists.

individual facts and circumstances of pediatrician

Acute nephritic syndrome a set of kidney disorders that can lead to

swelling or inflammation of internal parts of the kidney
Analgesic nephropathy damage caused to one or both kidneys due to too
much of a mixture of medications, commonly seen when there is an
overexposure to over-the-counter pain medications
Congenital nephrotic syndrome a genetically-passed disorder in which a
baby develops protein in the urine that causes swelling in the body
Chronic renal failure- the gradual loss of the kidney's ability to remove
body waste
Goodpasture syndrome a rare disease that causes kidney failure and lung
disease
Hypertension- high blood pressure
Interstitial nephritis a disorder in which the areas between the kidney
tubes become inflamed, which can affect the kidneys ability to manage
the bodys waste
Kidney removal surgery performed to remove all or part of a persons
kidney
Kidney stone a group of tiny crystals that are difficult to pass through the
body
Kidney transplant the placement of a healthy kidney in a patient with
kidney failure
Lithotripsy the use of shock waves to break up stones that have formed in
the kidney, bladder or the tubes that drain urine from the kidneys to the

 Membranous nephropathy a kidney disorder that causes

inflammation and structural changes inside the kidney, leading to
problems with the kidneys normal processes
Nephrocalcinosis a kidney disorder in which an excess amount of
calcium is left in the kidneys
Polycystic kidney disease a genetically-passed kidney disorder in
which multiple cysts form on the kidneys, causing them to enlarge
Post-streptococcal GN a kidney disorder caused by infection with
particular strains of the Streptococcus (strep) bacteria
Posterior urethral valve- the presence of valves within the urethra
that block the urine flowing out of the bladder
Vesicoureteral reflux- The back-up of urine toward the kidney
Reflux nephropathy Kidney damage due to vesicoureteral reflux
Renal papillary necrosis a condition in which all or part of the
openings of the kidneys collecting ducts die
Renal artery or vein thrombosis a blood clot in the artery or vein
in which blood passes from the kidney
Renal tubular acidosis- the build-up of body acid caused when
kidneys fail to excrete body acids

Nephrotic syndrome
Nephrotic syndrome is a condition which causes
the kidneys to leak large amounts of protein into
the urine.This canlead toa range of problems,
including swelling of body tissues and a greater
chance of catching infections.
Nephrotic syndrome is a kidney disorder that
causes your body to excrete too much protein in
your urine.
Nephrotic syndrome is usually caused by damage
to the clusters of small blood vessels in your
kidneys that filter waste and excess water from
your blood.
Nephrotic syndrome causes swelling (edema),
particularly in your feet and ankles, and increases
the risk of other health problems.

Causes of nephrotic syndrome

Minimal change disease. The most common cause of nephrotic syndrome in
children, this disorder results in abnormal kidney function, but when the
kidney tissue is examined under a microscope, it appears normal or nearly
normal. The cause of the abnormal function typically can't be determined.
Focal segmental glomerulosclerosis. Characterized by scattered scarring of
some of the glomeruli, this condition may result from another disease or a
genetic defect or occur for no known reason.
Membranous nephropathy. This kidney disorder is the result of thickening
membranes within the glomeruli. The exact cause of the thickening isn't
known, but it's sometimes associated with other medical conditions, such
as hepatitis B, malaria, lupus and cancer.
Diabetic kidney disease. Diabetes can lead to kidney damage (diabetic
nephropathy) that affects the glomeruli.
Systemic lupus erythematosus. This chronic inflammatory disease can lead
to serious kidney damage.
Amyloidosis. This disorder occurs when substances called amyloid proteins
accumulate in your organs. Amyloid buildup often affects the kidneys,
damaging their filtering system.
Blood clot in a kidney vein. Renal vein thrombosis, which occurs when a
blood clot blocks a vein connected to the kidney, can cause nephrotic
syndrome.
Heart failure. Some forms of heart failure, such as constrictive pericarditis
and severe right heart failure, can cause nephrotic syndrome.

treatment for nephrotic syndrome

There is no cure for nephrotic syndrome, but there are
treatments that can help you manage symptoms and prevent
more kidney damage. If your kidneys stop working, you will
need dialysis or a kidney transplant to live.
Your health care provider might tell you to take certain
medicines to treat the symptoms of nephrotic syndrome.
Medicines to control blood pressure and cholesterol can help
reduce your chances of having heart disease. Medicine to
help your body get rid of extra water can also help control
your blood pressure, and can reduce swelling. Medicines to
prevent blood clots can help prevent heart attack and stroke.
Changing your diet may also help you manage your
symptoms. Choosing fish or low-fat cuts of meat instead of
higher fat options can help keep your cholesterol under
control. Limiting how much salt (sodium) you take in can help
prevent swelling and help keep your blood pressure at a
healthy level.

Neurology
case
A 35-year-old businessman developed neck pain while lying on a
sofa with his head propped up resting against the sofa edge in his
home. He asked someone there to massage his neck. This was done
vigorously. Almost immediately, the pain became severe and he
was unable to turn his head. Next day he received neck
physiotherapy. The pain persisted. Two days later, he saw a
physician who prescribed analgesics and a cervical collar. For four
days, the pain was unrelieved so he went to an orthopedic surgeon,
who treated him symptomatically for eight days without
improvement. He then developed vomiting and diarrhea and the
headache became generalized, worse when sitting or standing. He
was hospitalized in his home town. MRI scan with venography
showed thrombosis of the superior sagittal and sigmoid sinuses,
and small bilateral subdural collections. He was treated with low
molecular weight heparin, then oral anticoagulants and aspirin and
was discharged. Two days later, he developed severe orthostatic
headache and required readmission. MRI scan with venography
showed no improvement. He was treated for a week again with low
molecular weight heparin, and discharged on oral anticoagulants.
He felt better for two days but the orthostatic headache recurred
with vomiting. Over the next two days, the headache became
continuous and unbearable.

 whole spinal cord showed partial re-canalization of the

previously thrombosed cerebral venous sinuses and only
minimal bilateral subdural collections. The previously
visualized spinal epidural collection remained. The patient
declined to have any further invasive procedure. He opted
for near total bed rest with adequate oral fluid intake. The
thrombophilia profile was normal. At review one month
later, he was symptom-free, apart from one episode of
migraine with aura. CT scan of the brain showed a thin
residual left subdural collection.
MRI scan showed bilateral subdural collections , the larger
left one requiring evacuation on the same day after
stopping anticoagulants and giving fresh frozen plasma and
platelets. The postoperative period was uneventful. As the
orthostatic nature of the initial headache suggested
intracranial hypotension, previous imaging studies were
reviewed. In the very first study, there were bilateral small
subdural fluid collections downward descent of brainstem
and enlarged epidural venous plexuses at the
craniovertebral junction and an anterior, epidural CSF
collection from the back of C2 vertebral body to the upper
dorsal vertebrae .These features were consistent with
intracranial hypotension due to CSF leak. Repeat venous
MRI of the brain and screening of the whole spinal cord

Clinical Cases

CASE 1:A 65-year-old right-handed man is being evaluated for a tremor

that has been present for approximately 20 years. It began
insidiously and has progressed gradually. It involves both hands and
affects his handwriting, drinking coffee and other liquids with a cup,
and general work that requires manual dexterity. Other people
occasionally notice a tremor in his head. He is otherwise healthy,
although he feels his balance is not quite as good as it used to be.A
glass of beer or wine markedly decreases the tremor severity. His
mother and daughter also have tremor. On examination he has a
rather regular tremor of approximately 8 cycles per second (Hz)
with his hands extended and also on finger-nose-finger maneuver.
Mild regular waviness is seen when writing or drawing spirals. His
tone is normal although, when performing voluntary movements
with one hand there is a ratchety quality felt in the tone of the
contra lateral arm. Occasional tremor is also noted in the head and
voice.

 CASE 2
A 40-year-old man presents to the psychiatry
emergency room for inappropriate-ate behavior and
confusion. He works as a janitor and has had
reasonably good work attendance. His coworkers say
that he has appeared fidgety for several years. They
specifically mention jerky movements that seem to
affect his entire body more recently. His mother is alive
and well, although his father died at age 28 in an auto
accident. On examination, he is alert but easily
distracted. His speech is fluent without paraphasias but
is noted to be tangential. He has trouble with spelling
the word world backwards and serial seven's, but
recalls three objects at 3 minutes. His constructions are
good. When he walks, there is a lot of distal hand
movement, and his balance is precarious,although he
can stand with both feet together. His reflexes are
increased bilaterally, and there is bilateral ankle clonus.
A urine drug screen is negative

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