Kidney Failure in Children

The two kidneys, each about the size of a fist, are bean-shaped organs located near the middle of the back, just below the rib cage. It functions to remove wastes and excess water from the blood. In addition, the kidneys also

 regulate blood pressure

 balance chemicals like sodium and potassium

 produce hormones to help bones grow and also help stimulate production of red blood cells

Kidney failure in children may occur as a result of direct injury to the kidneys, poisoning, or other diseases that may damage the kidneys.

When the kidneys totally stop working, treatment may involve dialysis or kidney transplantation.
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Causes of Kidney Failure in Children

Kidney failure may either be acute or chronic. Acute diseases develop quickly and can be very serious if not treated promptly. However, most cases of acute kidney failure lasts for only a short time and then goes away once the underlying cause is treated. Chronic diseases, on the other hand, tend to get worse over time.

Acute Kidney Failure

Acute kidney failure may result from direct injuries to the kidneys, loss of blood flow to the kidneys, and poisoning. Acute diseases that may cause kidney failure include hemolytic uremic syndrome and nephrotic syndrome.

Hemolytic uremic syndrome (HUS). HUS is a rare disorder that usually affects children under 10 years of age. It is results from eating foods that have been contaminated by bacteria leading to an infection in the digestive tract. Poisons produced by the bacteria can damage the kidneys, which can cause acute kidney failure.

Nephrotic syndrome. It is a set of signs that may point to kidney problem. Nephrotic syndrome is not a disease itself. However, it can be the first sign of a disease that damages certain structures in the kidney. A child with this condition can have high levels of protein in the urine; swelling around the eyes, legs, and belly; less frequent urination; and weight gain from excess water.

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Chronic Kidney Failure

A variety of conditions can lead to chronic kidney failure in children. Often, the disease goes unnoticed for many years until the kidneys have been permanently damaged. Treatment may delay the progression of some diseases. However, in many cases of chronic kidney disease, the child will eventually need dialysis or transplantation.

Some diseases or conditions that can lead to chronic kidney failure include:

Birth defects. Some babies are born with abnormally formed kidneys or without kidneys.

Blocked urine flow and reflux. Conditions or abnormalities that cause blockage of urine flow can cause urine to back up (reflux) and damage the kidney.

Inherited diseases. Hereditary diseases such as polycystic kidney disease (PKD) and Alport syndrome can cause kidney failure in children.

Glomerular diseases. Some conditions can damage the glomeruli—tiny filtering units in the kidney. Severe damage to the glomeruli can cause kidney failure.

Systemic diseases. Conditions such as diabetes and lupus can cause damage to the kidneys.

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Treatment of Kidney Failure in Children

Managing acute kidney failure involves treating the underlying cause. Once the underlying cause has been treated, kidney functions usually return to normal.

If a child’s kidneys have been totally damaged and fail completely, treatment to replace the work of the kidneys is necessary. Available treatment options are dialysis and transplantation.

Dialysis

Dialysis is a way to remove the toxins, wastes, and extra water from the blood of patients with kidney failure.

Kidney Transplantation

In kidney transplantation, the surgeon places a healthy kidney in the child’s body. The kidney may come either from a live donor or from someone who has just died. People who undergo transplantation must take medicines, called immunosuppressive drugs, to prevent the body’s immune system from rejecting the transplanted organ. However, taking these drugs can make the patient prone to infections.

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References:
National Kidney and Urologic Diseases Information Clearinghouse (February 2008). Childhood Nephrotic Syndrome (NIH Publication No. 08—4695). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/prostatitis/index.htm. Accessed: October 12, 2008

National Kidney and Urologic Diseases Information Clearinghouse (June 2006). Overview of Kidney Diseases in Children (NIH Publication No. 06—5167). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/childkidneydiseases/overview/index.htm. Accessed: October 12, 2008

National Kidney and Urologic Diseases Information Clearinghouse (December 2005). Hemolytic Uremic Syndrome (NIH Publication No. 06—4570). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/childkidneydiseases/hemolytic_uremic_syndrome/index.htm. Accessed: October 12, 2008

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Prostatitis

Prostatitis is a painful prostate gland disorder that commonly affects young and middle aged men. It may be difficult for doctors to diagnose prostatitis because many of the symptoms, such as burning feeling while urinating and incomplete emptying of the bladder could be signs of another urinary problem.

The prostate, a walnut-sized gland, is located in front of the rectum just below the bladder. It produces a fluid, which becomes a component of the semen. The prostate gland surrounds a part of the urethra—called the prostatic urethra—which is a common passageway for urine and semen.
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Types of Prostatitis

Prostatitis is the medical term for the inflammation of the prostate. However, doctors also use the term to describe four different disorders.

The different types of prostatitis are:

Acute bacterial prostatitis. Although considered as the least common type, acute bacterial prostatitis is a potentially life-threatening condition if left untreated. This type is the easiest to diagnose and treat effectively. It is caused by bacteria and occurs suddenly. Men with acute bacterial prostatitis often experience signs and symptoms, such as

 Fever and chills
 pain in the lower back and genital area
 frequent urination and urge to urinate (usually at night)
 burning or painful urination

Chronic bacterial prostatitis. This type of prostatitis occurs when bacteria find a place on the prostate where they can survive. Men with chronic bacterial prostatitis have urinary tract infections that seem to go away but then come back with the same bacteria.

Chronic (nonbacterial) prostatitis. Also called chronic pelvic syndrome, chronic prostatitis is the most common type. Although common, the reason why it occurs is not fully clear. This form can occur in men of any age. Its symptoms go away and then return without warning, and may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism, but do contain infection-fighting cells. The noninflammatory form, however, shows no evidence of inflammation and infection-fighting cells are also not present.

Asymptomatic inflammatory prostatitis. In this form, the patient does not complain of pain or discomfort. However, infection-fighting cells are found in his prostate fluid and semen. Asymptomatic inflammatory prostatitis is usually found when doctors are looking for causes of infertility or testing for prostate cancer.

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Diagnosis

Diagnosis of prostatitis is based on the patients medical history, signs and symptoms, and results of physical exam and laboratory tests. The doctor may also ask a series of questions from a standard questionnaire.

Physical exam may include digital rectal exam of the patient’s prostate. The doctor performs digital rectal exam (DRE) by gently inserting a gloved and lubricated finger into the patient’s rectum, just behind the prostate. The doctor can feel the back surface of the prostate to see if it is enlarged or tender to touch.

Urine tests may also be done to aid in the diagnosis of bacterial prostatitis. The doctor will examine samples of the patient’s urine for bacteria and white blood cells.

To rule out other conditions, the doctor may recommend other tests, such as imaging test, biopsy, blood tests, and test for bladder function.
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Treatment

Prostatitis caused by bacteria is treated with antimicrobials—medicines that kill microbes. The doctor will determine which medications are best for the patient and for how long he will take them.

Antimicrobials, however, are not effective against nonbacterial prostatitis. The patient should work with his doctor in finding an effective treatment.
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References:
National Kidney and Urologic Diseases Information Clearinghouse (January 2008). Prostatitis: Disorders of the Prostate (NIH Publication No. 08—4553). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/prostatitis/index.htm. Accessed: October 11, 2008

Rados, C. (2006). FDA Consumer Magazine – Prostate Problems: What Every Man Needs to Know. Retrieved October 12, 2008, from the U.S. Food and Drug Administration. Web Site: http://www.fda.gov/fdac/features/2006/306_prostate.html

Image Credit: NIDDK Image Library

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This Page Last Revised: September 28, 2009

Fallen Bladder (Cystocele)

Abnormal position of the bladder.

A cystocele, or fallen bladder, occurs when the wall between a woman’s bladder and her vagina weakens, which allows the bladder to droop into the vagina.

Cystocele may result from too much straining, such as during childbirth, heavy lifting, or repetitive straining during bowel movements. This condition may also occur in women who go through menopause. When women go through menopause, their bodies stop making estrogen—a hormone that helps keep the muscles around the vagina strong. The decline in estrogen may cause the muscles around the vagina and bladder to become weak.
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Classification

A cystocele may be mild, severe, or advanced.

In mild cystocele—grade 1—the bladder droops only a short way into the vagina. A cystocele is classified as severe—grade 2—if the bladder drops far enough to reach the opening of the vagina. Advanced—grade 3—cystocele occurs when the bladder bulges out of the opening of the vagina.
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Signs and Symptoms

Women with mild cases of cystocele may not experience symptoms. However, grade 2 and 3 cystocele may cause symptoms, such as:

 A feeling of incompletely emptying the bladder

 Urine leakage while coughing, sneezing, or laughing

 A bulge that may protrude through the opening of the vagina

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Diagnosis

The doctor may be able to diagnose cystocele (grade 2 and 3) from

 A description of your symptoms

 Physical examination—the fallen bladder will be visible with grade 2 or grade 3 cystocele

 Imaging tests, such as voiding cystourethrogram. This test involves taking x rays of the bladder during urination

Other tests may be needed to find out problems in other parts of the urinary tract.
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Treatment

Mild cystocele may not require special treatment. However, surgery may be recommended for a more serious cystocele.

If a cystocele does not cause symptoms or complications, the doctor may only recommend avoiding activities, such as heavy lifting or straining that could worsen the condition.

In a more bothersome cystocele, the doctor may recommend a pessary. A pessary is a device that is placed in the vagina to hold the bladder in place. However, pessaries must be removed regularly to avoid infections or ulcers. (Learn more about pessaries.)

In advanced cystoceles, surgery may be needed to move and keep the bladder in a more normal position.

Your doctor will be happy to answer your questions regarding cystocele or explain about treatment options that are available.

Reference:
National Kidney and Urologic Diseases Information Clearinghouse (August 2007). Cystocele (Fallen Bladder) (NIH Publication No. 07–4557). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/cystocele/index.htm. Accessed: October 5, 2008

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