Pediatric nephrology is the branch of medicine that cares for kidney and urinary tract problems in babies, children and teenagers. It differs from adult kidney care because children are still growing, their kidney problems usually have different causes, and parents share in the decisions until a teen is ready to take over.
Key Takeaways
- Pediatric nephrologists are doctors who treat kidney and urinary tract problems in children, but they do not do surgery; pediatric urologists do.
- Nearly 60 percent of chronic kidney disease in children comes from birth defects of the urinary tract, while diabetes and high blood pressure are the most common causes in adults.
- Early kidney disease in children often causes few or no symptoms, so blood or protein in the urine is often first found at a routine checkup.
- Swelling around the eyes, foamy or cola-colored urine, changes in how much a child urinates and slow growth are reasons to call your child’s doctor.
- Teens with ongoing kidney disease move to adult care step by step, and families usually start talking about it at about age 12 to 14.
What Does a Pediatric Nephrologist Do?
A pediatric nephrologist is a kidney specialist for infants, children and teens. The National Kidney Foundation (NKF) explains that pediatric nephrologists care for kidney and urinary tract problems in children but do not do surgery. When a child needs an operation, for example to fix a urine blockage, that is the job of a pediatric urologist, a surgeon trained in children’s urinary and genital tracts.
For the basics of kidney medicine at any age, see our post on what nephrology is and when to see a kidney doctor.
How Is Pediatric Nephrology Different From Adult Nephrology?
The biggest difference is the cause. In adults, the most common causes of chronic kidney disease (CKD) are diabetes and high blood pressure. In children, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that birth defects that keep the urinary tract from developing normally cause nearly 60 percent of CKD.
Growth and development also shape care:
- Growth: about one-third of children with moderate to severe CKD are shorter than 97 in 100 children of the same age and sex.
- Learning: kidney disease can affect concentration, learning, and language and motor skills.
- Medicines: children respond differently to medicines than adults do.
- Family: parents manage appointments and medicines, and they may learn home treatments such as peritoneal dialysis alongside the child.
What Kidney Problems Are Common in Children?
Kidney disease is not common in children. When it does happen, NIDDK lists these main causes:
- Birth defects, such as a missing kidney or kidneys that did not develop normally
- Inherited diseases, such as polycystic kidney disease and Alport syndrome
- Infections, including hemolytic uremic syndrome (HUS), most often caused by an E. coli infection of the digestive system
- Nephrotic syndrome, in which the kidneys leak large amounts of protein
- Whole-body diseases, such as lupus
- Urine blockage, or reflux, where urine flows backward from the bladder toward the kidneys
Nephrotic syndrome most often affects children 2 to 7 years old, particularly boys, and swelling around the eyes is its most common sign.
Childhood kidney problems can matter for life: NIDDK guidance for doctors notes that a majority of the diseases that cause kidney failure in adults have their origins in childhood. High blood pressure is one example to watch. Cleveland Clinic lists overweight, a high-sodium diet and lack of exercise among the risk factors for high blood pressure in children, and notes that children’s blood pressure checks usually start at age 3. Learn more about how blood pressure affects kidney health.
What Signs Should Parents Not Ignore?
Blood in the urine (hematuria) and protein in the urine (proteinuria) are common early findings, and they are often caught at a routine checkup rather than because a child feels unwell. Our guide to protein in the urine explains proteinuria, and our post on why pediatric kidney health deserves more attention explains why regular checkups matter.
As kidney disease progresses, NIDDK lists signs such as swelling in the feet, legs, hands or face; foamy, pink or cola-colored urine; passing more or less urine than usual, or wetting the bed; tiredness, poor appetite or vomiting; and slow growth. In babies under age 2, a urinary tract infection may show up only as fever, fussiness or poor feeding, so an unexplained fever is worth a call to the doctor.
When Is a Child Referred to a Pediatric Nephrologist?
The referral usually comes from your child’s pediatrician or family doctor. NIDDK guidance for doctors lists reasons to refer, including:
- protein in the urine, or blood seen only under a microscope together with protein
- blood pressure that stays high
- a blood test showing lower kidney function
- passing large amounts of urine, or urine that is too dilute
- a stone in the urinary tract, or repeated bladder or kidney infections
Some babies are referred soon after birth. NKF notes that hydronephrosis, when part of the urinary tract fills with too much urine, is the most common abnormality found on prenatal ultrasound. The specialist may order urine and blood tests, imaging, and sometimes a kidney biopsy or genetic tests.
When Does a Child Need Medical Care Right Away?
Call 911 if your child has a seizure or trouble breathing. Get medical care the same day, or go to an emergency room, if your child has:
- much less urine than usual, especially with swelling or extreme tiredness
- unusual bleeding or unexplained bruises, especially after an illness with bloody diarrhea
- signs of a kidney infection, such as fever and chills, vomiting, or pain in the back, side or groin
Make an appointment soon for swelling around the eyes that does not go away, foamy or pink urine, accidents after toilet training, or slow growth.
How Do Teens Move From Pediatric to Adult Kidney Care?
NKF describes the move to adult care as a process that begins in adolescence and ends when the young person is fully part of adult care. Families and the care team usually raise the idea at about age 12 to 14, but timing depends more on the teen’s abilities, when they were diagnosed and whether their condition is stable than on age.
In pediatric care, parents often handle appointments, medicines and insurance; in adult care, the young adult is expected to. NKF suggests teens practice making appointments, refilling prescriptions, describing their health history and knowing which symptoms are an emergency. Parents can help by letting teens answer questions first and giving them private time with the provider. These years matter: NKF notes that teens and young adults aged 17 to 24 who have had a kidney transplant have a higher chance of transplant failure than other age groups.
Frequently Asked Questions
Is Kidney Disease Common in Children?
No. NIDDK says kidney disease is not common in children, although the exact number is unknown because many children have few early symptoms.
Is Protein in a Teen’s Urine Always a Sign of Kidney Disease?
Not always. Some teens have orthostatic proteinuria, where protein leaks into the urine only while standing, and NKF calls it a variation of normal that needs no treatment. Protein can also rise briefly with a fever or illness, so doctors usually recheck it.
Can Children Have Dialysis or a Kidney Transplant?
Yes. Hemodialysis is usually done three times a week at a center, and peritoneal dialysis is usually done at home after training. About one-third of kidneys transplanted into children come from living donors, and some children get a transplant before ever starting dialysis.
Can Kidney Disease in Children Be Prevented?
Not yet. NIDDK says researchers have not found a way to prevent childhood kidney disease. Early treatment and careful management of complications can slow it down, which is one more reason checkups matter.
How Can I Help Protect My Child’s Kidneys Day to Day?
Keep up with checkups, help your child take medicines as prescribed, and follow any eating or fluid plan from the care team. Ask the care team before giving any medicine, supplement or probiotic that was not prescribed.
Talk to ANC About Kidney Care
If you have questions about kidney care, Contact ANC or call 651-772-6251, Monday to Friday, 8:30 AM to 4 PM. If you are worried about your child’s kidneys, start with your child’s doctor, who can refer your child to a pediatric nephrologist when one is needed.
Sources
- NIDDK: Kidney Disease in Children
- NIDDK: Nephrotic Syndrome in Children
- National Kidney Foundation: Transitioning From Child to Adult Chronic Kidney Disease (CKD) Care
- National Kidney Foundation: Proteinuria in Children
- Cleveland Clinic: High Blood Pressure in Children
Medical Disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your specific care and treatment options.
