Nephrology and Hypertension - Patient Care and Treatment

Nephrology and Hypertension - Patient Care and Treatment

Learn more about symptoms and treatments for kids’ kidney and blood pressure problems from Penn State Children’s Hospital Pediatric Nephrology and Hypertension. 

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717-531-6807

Advanced care from an expert team

The doctors at Penn State Children’s Hospital Division of Pediatric Nephrology and Hypertension work as a team. Doctors, nurses, dietitians, social workers and other specialists all work together to care for your child.

We test for and treat the following conditions in children of all ages.

Blood in the urine

What is it?

Kidneys filter water and waste from the blood, which then leaves the body through the urine. A healthy child may have very small amounts of blood in their urine - amounts that are too small to see with the naked eye. But when your child’s urine looks red, brown or “tea-colored,” they may have blood in the urinary system and should see a doctor right away.

Several problems can cause blood in the urine. These include:

  • Acute and chronic glomerulonephritis (sudden or ongoing diseases that harm the blood-filtering part of the kidney)
  • Kidney stones
  • An injury to the bladder (trauma)
  • Inflamed bladder

How is it treated?

Our doctors will give your child blood and urine tests. These tests may show a problem, or more tests may be needed. Your child’s treatment will depend on what’s causing the bleeding.

Protein in the urine

What is it?

Urine naturally has traces of protein. But if there’s kidney damage, more protein may show up in the urine. This means your child is losing too much protein every day, which may cause protein in the blood to drop too low. 

When this happens, the body holds onto more water. This leads to swelling, weight gain and sometimes high blood pressure. Conditions that increase protein in the urine include:

How is it treated?

Infants, children and teens with protein in their urine will need blood and urine studies.  Occasionally they will also need an ultrasound of their kidneys or perhaps a kidney biopsy to help understand the cause of the protein leakage. Your child may need medicine to:

  • Treat the protein loss
  • Help the body release water
  • Prevent weight gain
  • Prevent or treat high blood pressure

Kidney problems at birth (congenital)

What is it?

Sometimes babies are born with kidney damage because their kidneys did not develop normally in the womb. Fortunately, most women today have prenatal (before birth) ultrasound exams. This lets doctors see when organs aren’t developing normally.

Some examples of kidney birth defects include:

  • Renal dysplasia
  • Renal hypoplasia
  • Renal cystic disease
  • Hydronephrosis
  • Renal obstruction

How is it treated? 

Babies born with kidney damage will need to have follow-up blood tests and ultrasounds to see how their kidneys develop and work after birth. If the kidney damage is serious, these children may need special medicines. Sometimes, surgery may help correct or limit problems. Our doctors work closely with pediatric urologists (urinary tract surgeons) to test and treat these children.

Glomerulonephritis

What is it?

The glomeruli are the microscopic filters that start the process of urine formation. There are about 1 million glomeruli within each kidney. In medicine, whenever a word ends in “itis” it means inflammation.  While inflammation can be seen with infections, your body can develop inflammation without any evidence of infection. This inflammation often leads to glomerular damage, with blood and protein being lost into the urine. When we diagnose a child as having glomerulonephritis, we still have to go on to understand the cause of the inflammation and whether we think the inflammation will cause temporary or permanent damage to the kidneys.  We can usually detect inflammation within the kidney with blood and urine tests but sometimes we may need to do a kidney biopsy in order to be sure about the amount and type of inflammation. 

How is it treated?

Some types of glomerulonephritis cause sudden (acute) kidney failure but with good care, the kidneys actually heal by themselves. Children with chronic glomerulonephritis often need special medications to help control the kidney inflammation and keep the kidneys further damage. Unfortunately, sometimes even with the use of these medicines, the kidney damage progresses and the child develops chronic kidney disease and even end-stage kidney disease.

Sudden (acute) kidney failure

What is it?

Kidney failure is when the kidney can’t filter waste and water from the blood. This can happen suddenly, as part of an infection or inflammation. It may happen slowly, as part of a general health problem. 

When kidney failure is sudden, the body doesn’t have time to adjust. This can cause:

Acute kidney failure is an emergency. If your child has sudden swelling and weight gain, with less urination or bloody urine, call his or her doctor right away. Acute kidney failure can range from mild to severe. Some things that can lead to sudden kidney failure include:

  • Severe diarrhea and dehydration
  • Acute glomerulonephritis
  • Hemolytic-uremic syndrome
  • Henoch-Schonlein purpura

How is it treated?

Treatment starts by making sure your child is safe. We check and adjust their body’s chemical levels. This is done with medicines and special diets. If needed, dialysis can help keep body chemicals and fluid levels safe.

With proper treatment, there is a good chance that the kidneys will heal themselves and return to normal or near-normal levels. We will follow your child’s progress and adjust treatment as needed until the kidneys are working again.

Ongoing (chronic) kidney disease

What is it?

When children are born with abnormal kidneys or when they develop acute kidney failure that does not heal, they have chronic kidney disease. Chronic kidney disease is when kidney function remains below normal for at least three months.

Since the decrease in kidney function is gradual, the body adapts well to the change. Medicine may not be needed until kidney function drops to less than 50% to 60% of normal. Some of the problems associated with chronic kidney disease in children include:

  • Poor nutrition and growth
  • High blood pressure
  • Abnormal body chemical levels
  • Bone disease
  • Low blood counts (anemia)

How is it treated?

Chronic kidney disease cannot be cured. But we can offer medicines and special diets to delay the loss of kidney function and keep your child healthy. When medicine and diet don’t help, and the kidneys continue to get worse, they can reach what it is called end stage kidney disease.

Some problems that lead to chronic kidney disease include:

End stage kidney disease and dialysis

What is it?

When chronic kidney disease can’t be treated with medicine or diet changes, your child may develop end stage kidney disease. When the kidneys no longer work well enough to keep your child active and healthy we call that end stage kidney disease.

How is it treated?

Fortunately, there are successful treatments available for children who have end stage kidney disease. The most effective treatment is to transplant a healthy kidney from a donor to the child. In some cases, your child will have dialysis before kidney transplant surgery.

  • Dialysis - this is a way to help clear the body of waste and water.
    • It can be performed by peritoneal dialysis (where a tube is placed in the abdomen) or hemodialysis (where the blood is taken out of the body to be filtered and then returned to the body).
    • Both methods cleanse the blood and remove extra fluid.
    • Your doctor will talk to you and your child about the pros and cons of each before you decide on treatment.
    • Dialysis works well, but not as well as a kidney transplant.
    • Children on dialysis need to follow a special diet and take medicines to keep them healthy.
    • During dialysis treatment, you will work with the kidney team to adjust the treatments and medicines for your child as needed.
  • Kidney transplantation - the success rates for kidney transplants in children have greatly improved in recent years.
    • Three years after a transplant, 90% of children continue to have working kidneys.[1]
    • Donated kidneys can come from either a living person or a volunteer organ donor who has passed away.
    • Once a kidney transplant is complete, patients need to take medicines to keep the new kidney working.
    • Our pediatric nephrology team is continues to care for patients after their transplant surgery.

[1] National American Pediatric Renal Trials and Collaborative Studies, 2012

High blood pressure

What is it?

About 4% to 5% of kids have high blood pressure (hypertension). When a specific reason for the high blood pressure can be found, kidney problems are the most likely cause of high blood pressure problems in children.

There are two reasons why:

  1. The kidneys control how much water leaves the body. When water builds up in the blood vessels, they expand and cause blood pressure to rise.
  2. The kidneys make a chemical that can raise blood pressure. When a kidney is damaged, it may make more of that chemical, leading to high blood pressure.

Another cause of high blood pressure in children is weight gain or obesity. Sometimes, especially in teens and adults, there is no known cause. This is called essential or primary hypertension

How is it treated?

High blood pressure treatment depends on the cause. Blood tests, as well as kidney and heart ultrasounds, can help find the cause. Generally, the younger the child with high blood pressure, the more likely there is to be a specific cause.

People with high blood pressure should:

  • Limit salt
  • Exercise
  • Lose weight or limit weight gain if overweight

There are many blood pressure drugs available. Your doctor will work with you to find the best treatment for your child.

Kidney stones

What are they?

Kidney stones are more common in adults than children. Many children with kidney stones have a family history of other relatives who also have had kidney stones. The most common cause of kidney stones in children is too much calcium in their urine.

What are symptoms of kidney stones?

  • One-sided back pain that seems to get better and then worse several times during the episode
  • Pain that’s mild to severe
  • Vomiting

Ultrasound or other radiology studies can check for kidney stones.

How are they treated?

Kidney stones often come out in the child’s urine.

  • If you can, please save the stone to have it checked.
  • After the stone is passed, your child should see a specialist to help find what caused it.

Usually, calcium in the urine causes kidney stones, but other chemicals can cause them too. We’ll ask you to collect your child’s urine samples for 24 hours so we can test the urine along with blood samples.

If your child has a kidney stone that is causing pain:

  • Make sure they drink lots of fluids. Extra urine helps pass the kidney stone.
  • Take you child to an emergency room if pain is severe. They may give pain medicine and possibly intravenous (IV) fluids to help pass the stone.

All patients with a history of kidney stones need to drink more water until their urine is clear. This will help dilute chemicals in the body and keep stones from forming. Other treatments depend upon the type of kidney stone and the chemical makeup of the urine.

Contact us

Phone: 717-531-6807
Fax: 717-531-5708