Pediatric Nephrology is a multidisciplinary center that offers expert diagnosis, treatment and management of all types of kidney and hypertensive disorders in infants, children, and adolescents. Our specialists include skilled and experienced pediatric nephrologists, imaging specialists, pediatric nurses and a team of many other multidisciplinary specialists. We are committed to provide the best possible care for children with kidney disorders.
Common Diseases We Treat:
- Acute kidney injury
- Bartter Syndrome
- Chronic kidney disease (U of U)
- Congenital kidney disorders
- Hematuria (Blood in urine)
- Hypophosphatemic rickets
- Interstitial nephritis
- Kidney stones
- Multicystic dysplastic kidney
- Nephrogenic diabetes insipidus
- Nephrotic syndrome
- Polycystic kidney disease
- Prenatal consultation for in utero kidney disorders
- Proteinuria (Protein in urine)
- Recurrent urinary tract infections
- Renal tubular acidosis
- Single kidney
Treatments & Specialized Testing
- 24 hour Ambulatory Blood Pressure Monitoring
- Hemodialysis and Peritoneal Dialysis (U of U)
- Kidney Transplantation (PCH)
Phone: (801) 213-3599
Fax: (801) 587-7539
Phone: (801) 662-7770
Phone: (801) 662-6800
Overview of Kidney Disorders in Children
How do the kidneys work?
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood.
The kidneys and urinary system keep chemicals, such as potassium and sodium, and water in balance by removing a type of waste, called urea, from the blood. Urea is produced when food containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.
Two kidneys, a pair of purplish-brown organs, are located below the ribs toward the middle of the back. Their function is to:
Remove liquid waste from the blood in the form of urine
Keep a stable balance of salts and other substances in the blood
Produce erythropoietin, a hormone that aids the formation of red blood cells
The kidneys remove urea from the blood through tiny filtering units called nephrons. There are about one million nephrons in each kidney, located in the medulla and the cortex. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule.
Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney. Urine collects in the calyces and renal pelvis and moves into the ureter, where it flows down into the bladder.
In addition to filtering waste from the blood and assisting in the balance of fluids and other substances in the body, the kidneys perform other vital functions. These functions include:
Production of hormones that help to regulate blood pressure and heart function
Conversion of vitamin D into a form that can be used by the body’s tissues
What is nephrology?
Nephrology is the branch of medicine concerned with the diagnosis and treatment of conditions related to the kidneys. Other health professionals who treat kidney problems include primary care doctors, pediatricians, and urologists.
What causes problems with the kidneys?
In children, problems of the urinary system include acute and chronic kidney failure, urinary tract infections, obstructions along the urinary tract, and abnormalities present at birth.
Diseases of the kidneys often produce temporary or permanent changes to the small functional structures and vessels inside the kidney. Frequent urinary tract infections can cause scarring to these structures leading to renal (kidney) failure. Some diseases that cause kidney damage include:
Hemolytic uremic syndrome
Polycystic kidney disease
Urinary tract infections
Disorders of the genitourinary system in children are often detected by fetal ultrasound prior to birth. If not detected on fetal ultrasound, often children will develop a urinary tract infection that will prompt your child's doctor to perform special diagnostic tests that may detect an abnormality. Some diseases of the kidney do not reveal themselves until later in life or after a child has a bacterial infection or an immune disorder.
High Blood Pressure in Children and Adolescents
What is blood pressure?
Blood pressure, measured with a blood pressure cuff around an arm or leg, is the force of the blood pushing against the artery walls.
Two numbers are recorded when measuring blood pressure:
The higher number, or systolic pressure, refers to the highest pressure inside the artery. It occurs when the heart contracts and pumps blood out to the body.
The lower number, or diastolic pressure, refers to the lowest pressure inside the artery. It occurs when the heart relaxes and fills with blood.
Each time the heart beats, it pumps blood into the arteries, resulting in the highest blood pressure, the systolic pressure, as the heart contracts, and the lowest blood pressure, the diastolic pressure, as the heart relaxes.
Both the systolic and diastolic pressures are recorded as "mm Hg" (millimeters of mercury).
What is high blood pressure?
High blood pressure means that there is higher than normal pressure inside the arteries either during systole (when the heart contracts and pumps blood through the body), or during diastole (when the heart relaxes and fills with blood.)
If the pressure is high during the pumping phase (systole), then the first number recorded with a blood pressure reading (the systolic pressure) will be high.
If the pressure is high during the relaxation phase (diastole), then the second number recorded (the diastolic pressure) will be high.
High blood pressure is also called hypertension.
Is a blood pressure reading always the same?
Blood pressure can be affected by many factors, including, but not limited to, the following:
The time of day. Blood pressures fluctuate during waking hours, and are lower during sleep.
Physical activity. Blood pressure is usually higher during and immediately after exercise, and lower at periods of rest.
Emotional moods and stress. Feelings such as fear, anger, or happiness can affect the blood pressure.
Age, height, weight, and gender. Each of these can affect blood pressure.
Other illnesses present or medications you are taking. Other illnesses, including kidney disease or heart disease, affect blood pressure, as can certain medications.
Adolescents may be anxious in a doctor's office, not knowing what may happen. Your doctor is aware that any emotions related to visiting the clinic can affect blood pressure and may give falsely high readings.
Before determining that your child has high blood pressure, a doctor or nurse will take several readings when your child is calm.
When is the blood pressure too high?
Blood pressures vary depending on the age of your child, as well as according to his or her height, weight, and gender. For example, an infant may have a quite normal blood pressure of 80/45, while that value in an adult is considered low. A teenager may have an acceptable blood pressure of 110/70, but that value would be of concern in a toddler. Generally, blood pressure is low in infancy, and rises slowly as children age. Boys' blood pressures are slightly higher than girls', and taller people generally have higher blood pressures than short people.
The National Heart, Lung, and Blood Institute (NHLBI) has prepared a series of age- and gender-specific blood pressure measurement tables for children ages 3 through 17 years, based on percentiles. A range of blood pressure values is given based on how old and how tall your child is. According to the tables, if your adolescent has a blood pressure that is higher than 90% to 95% of other males or females his or her age and height, then he or she may have high blood pressure.
Why is high blood pressure a concern?
High blood pressure, or hypertension, directly increases the risk of coronary heart disease (heart attack) and stroke.
Heart attack and stroke related to high blood pressure are rare in children and adolescents. Yet, high blood pressure can start without any other signs or symptoms and persist undetected for years if not measured. If undiagnosed high blood pressure exists in childhood, then young adults in their 20s can begin to exhibit harmful effects on their heart and blood vessels that can lead to heart attacks and stroke.
What causes high blood pressure?
Blood pressure is classified as "primary," or without a definite cause, and "secondary," related to an illness or behavior.
Risk factors for primary hypertension in adults, and possibly in children and adolescents, include the following:
High blood cholesterol levels
Secondary causes of hypertension in children and adolescents include the following:
Kidney and heart disease
Use of prescription medication (such as steroid medication or birth control pills) or illegal recreational drugs (such as cocaine)
Who is at risk for developing high blood pressure?
Primary hypertension (with an unknown cause) is the most common cause of high blood pressure in adolescents and adults, but is less common in children.
Many children with high blood pressure also have adult relatives with hypertension, indicating there may be a hereditary aspect to the disease.
There is a higher incidence of high blood pressure in African-American children after the age of 12 and into adulthood.
Increased rates of obesity have increased the risk of developing high blood pressure in children.
How is high blood pressure diagnosed?
Your adolescent's doctor may note an elevated blood pressure reading during a routine office visit. Obtaining calm, resting blood pressures on several different occasions (days, weeks, or months apart) will give better information about whether the blood pressure elevation is consistent or due to fear or stress.
Your adolescent's doctor will take a medical history, including information about your adolescent's diet, exercise level, home and school activities, and possible stressors. A physical exam may also be done.
Additional diagnostic tests, such as urine tests, blood tests, and ultrasound examination of the kidneys, may help your doctor determine the origin of your child's high blood pressure.
Treatment for high blood pressure
Specific treatment for high blood pressure will be determined by your adolescent's doctor based on:
Your adolescent's age, overall health, and medical history
Extent of the condition
Your child's tolerance to specific medications, procedures, or treatments
Expectations for the course of the condition
Your opinion or preference
If a secondary cause has been found, such as kidney disease, the disease will be treated. If no cause has been determined, the first treatment approach often involves making appropriate lifestyle changes, including one, or more, of the following:
Increased physical activity
These interventions can lower systolic and diastolic blood pressure, improve the strength of the heart, and lower blood cholesterol. These are all important in preventing heart disease as an adult.
High blood pressure usually responds to treatment with these healthy lifestyle modifications. Medications to control high blood pressure are usually not needed in children and adolescents with the disorder.
|PCH Outpatient Services at Riverton||(801) 581-7609|
|University Hospital||(801) 213-3599|
Pediatric Nephrology, Pediatric Nurse Practitioner
|University Hospital||(801) 213-3599|
|University Hospital||50 N. Medical Dr.
Salt Lake City, UT 84113
|PCH Outpatient Services at Riverton||3773 West 12600 South
Riverton, UT 84065
|Eccles Primary Children's Outpatient Services||81 N. Mario Capecchi Dr.
Salt Lake City, UT 84113