Paediatric Nephrology Clinic

The nephrology clinic deals with children who have a problem relating to their urinary system which includes the kidneys, the bladder and other related tubes. The role of the kidneys in the body is to get rid of wastes from the blood stream. Kidneys also play a role in the little one`s electrolytes ( minerals like potassium, sodium and many others ) making sure that they are balanced out correctly with the water in the body tissues.  Kidneys also produce a hormone that makes sure the child makes enough red blood cells.

At the Gertrude`s children Hospital we have a team of specialists  that will make sure your child`s kidney problems are looked into as soon as they are noted.  This will include accurate testing of your child`s kidney function tests, blood pressure no matter how tiny they are and other relevant blood tests. Common problems that are addressed at the specialist nephrologist clinic include urinary tract infections, bedwetting , paediatric high blood pressure among many others. Consult  your general paediatrician or specialist paediatric nephrologist and have all your concerns addressed professionally.

 

BEDWETTING IN CHILDREN  

Is bedwetting normal in children? 

Four percent of children wet their beds up to their third birthday.  By the age of 6 this reduces to only 15%. A few continue to wet their beds occasionally until they are 12 years old.  Bedwetting has a large familial component. If you (as the parent) wet the bed as a child, your child may continue to wet the bed too. This is often a normal part of development.   

What can I do to help my child who still wets the bed? 

  1. Limit fluids before bedtime (at least 2 hours) 
  1. Remove any food or drink triggers that you may have noted increase the likelihood of bedwetting. 
  1. Reassure the child that it is nothing to be ashamed of and that he/she will eventually outgrow the problem. 
  1. Use an alarm system to wake your child or ask your doctor to prescribe the alarm device used to wake your child when they begin to wet the bed.(xxxx link to pharmacycontact) This method has been shown to assist over 75% of children who use it for more than 3 months.  
  1. Make sure family, friends, schoolmates and siblings do not tease your child over the issue. 
  1. Investigate and address any social family or academic problem that may be stressing the child. You can receive assistance from our specialist psychiatry clinic. (xxxx link specialist) 
  1. Reward your child for the effort made towards staying dry like waking up to the alarms and avoiding late night drinks and NOT only the dry night.  

When should I worry about my child`s bedwetting? 

  • When a child who had been dry for some time restarts bedwetting. 
  • When there are other associated symptoms like urgency( being unable to hold urine when the urge strikes), frequency ( requiring to pass urine frequently), blood stains in urine or underwear, cloudy urine  and pain or a burning sensation when passing urine.  

What could the above symptoms mean? 

Occasionally bedwetting may occur due to an infection, diabetes or other abnormalities of the bladder or kidneys. These occur in less than 1% of the cases of bedwetting.  

A child that had developed to a point of  dry nights and restarts bedwetting may be undergoing family or school stress and this needs to be addressed.  

What to expect  when I consult my doctor?  

You should be reviewed by a general outpatient doctor/ paediatrician. 

You will be asked questions about a family history of bedwetting, triggers in terms of foods or drink and any other unusual symptoms you may be concerned about. 

You may be sent to the laboratory (link xxxx lab) for a urine test to check for any infections. They may also order other tests they may find necessary.  

If your child is found to have a urinary tract infection (xxxxUTI) it will be treated as such and the bedwetting may gradually stop. If it persists, they may refer your child to a specialist who deals with the kidneys and urinary system. 

In special situations for a child above 7 years of age, there are medications that may be prescribed to reduce your child’s chances of wetting the bed. These may be considered before a camp out, sleep over, boarding school situations  whereby the child may face ridicule for wetting the bed.  

 

Urinary Tract Infections (UTIs) in Children   

What is a Urinary tract infection? 

This is an infection of one or more parts  of the urinary system. This involves the bladder, kidneys, and the tubes involved known as the urethra and ureters. It is quite common in children especially girls (8%) and boys (2%) and is different from sexually transmitted infections.  

How do children get UTIs? 

The commonest way that children get urinary tract infections is by an ascending bacteria from their skin or poop (stool). The urinary path is very sterile (clean) and has no bacteria whereas the digestive system has a lot of bacteria. The infection may affect either of the four areas of the system. These include:- 

  1.  The kidneys ( where urine is made after filtering out wastes) and this is called  pyelonephritis.   
  1. The ureters ( two tube that allows urine to pass from the kidneys to the bladder) 
  1. The bladder which is a bag that collects and stores urine until it is passed out. When the bladder is infected we call it cystitis.  
  1. The urethra (the tube that allows urine to flow  from the bladder out as the child passes urine.) This is quite short and wide in girls and that is why UTis are more common in girls than boys.  

What are the symptoms of UTIs 

Children commonly will present with non-specific signs like:- 

  • Vomiting 
  • Fever 
  • Irritability or fussiness 
  • Reduced appetite  
  • Failure to thrive/grow in a healthy manner 

Older children may have specific signs that include:- 

  • Abdominal pain that may be on the back, sides or lower tummy areas.  
  • Pain when passing urine 
  • The need to urgently pass urine 
  • Frequently passing urine 
  • Foul smelling or cloudy urine 
  • Some children who are already toilet trained may lose control to hold urine. 
  • Other children who had been dry at night may begin to wet the bed 

How is a UTI diagnosed?  

The doctor will take a urine sample for testing in the laboratory. This test is known as microscopy, culture and sensitivity. The result comes out in two or more phases. The first result which is the microscopy and dipstick comes out immediately and will guide the immediate treatment. After 72 hours( three days) , the laboratory will release the culture result. ( this is a test where the laboratory attempts to grow and identify the specific type of bacteria in the urine and check which antibiotic will eradicate it effectively) Your child`s treatment need not wait for the culture result.  

How is urine collected? 

A small child who is not potty trained will have a plastic urine bag fitted around the genital area by the laboratory staff beneath the diaper/ nappy.  You will then be asked to breastfeed the child as you keep checking whether they have passed any urine. The laboratory staff will remove the bag and collect the urine for you.  

 

For older children, you will be requested to give a clean catch (midstream urine sample). This means you should clean your child`s genital area well with clean water. You will then tell them to start passing urine and collect a sample midway as they pass urine. About 10mls is required. The girls get a wider bottle and the boys a slimmer one that is already labelled with your child`s details. You will then return the sample to the laboratory in a brown bag. Make sure the sample gets to the laboratory within less than 2 hours from the time of voiding.   

How are UTIs treated? 

  1. The child is encouraged to drink or breastfeed regularly in order to maintain a good fluid intake 
  1. Paracetamol is given to manage pain and fever 
  1. Antibiotics will be prescribed .These are taken for 7-10days.  This will follow the hospital guidelines at first/ immediate treatment. In case the symptoms are still present after three days the doctor may decide to change your antibiotic after looking at your child`s urine culture results. It is important to complete your dose even when your child begins to feel better. This prevents antibiotic resistance.  
  1. Ten days after your child completes their antibiotics, another urine test will be conducted to confirm successful treatment.  
  1. If your child gets repeated UTIs they should be seen by a specialist nephrologist or paediatrician.  

What should I expect at the specialist nephrology clinic?  

The doctor will be checking whether there are other reasons why your child keeps getting a UTI. They may send you for an ultrasound which uses sound waves to show any blockages or problems in your kidneys,  a micturating-cysto-urethrogram(MCU)  or CT Scan depending on their assessment.  

How can I prevent UTIs in my child from recurring in the future? 

  1. Change your baby`s diaper often to prevent bacteria from growing 
  1. Teach your daughter good bathroom habits as they get older. Girls should always wipe from front to back. This helps stool from the back and bacteria from the vaginal opening from getting to the urethra which is at the front.  
  1. Encourage your child not to hold urine in and use the washroom as soon as they feel the urge.  
  1. Avoid bubble baths and perfumed soaps in girls 
  1. Make sure your child always wears clean, well died and absorbent underwear  
  1. Encourage your child to drink a lot of water whenever they are thirsty and keep well hydrated  
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