Kidney & Urinary System

When blood gets into urine (pee), it’s known as hematuria (hee-ma-TUR-ee-uh). Hematuria is pretty common, and most of the time it’s not serious.

Peeing is one way the body gets rid of waste products. The process starts in the kidneys, which remove excess fluids and waste from the blood and turn them into urine. The urine then flows through tubes called ureters into the bladder, where it’s stored until it’s peed out. If blood cells leak into the urine at any part of the process, it causes hematuria.

The two kinds of hematuria are:

1. Microscopic hematuria is when blood in the urine is invisible to the naked eye; it only shows up under a microscope. In many cases, microscopic hematuria goes away without causing any problems. In fact, people might never know they have it unless they get a urine test.
2. Gross hematuria is when you can see the blood in the urine. This is because there are enough red blood cells in the urine to turn it red or tea-colored. Gross hematuria usually goes away on its own with no problems, but sometimes it’s a sign of a more serious condition. In those cases, doctors will treat the underlying cause.

Causes

A person can get hematuria for many reasons. The more common causes are:

• bladder or kidney infections
• kidney stones
• high levels of calcium and other minerals in the urine
• abnormal development of any part of the urinary tract
• menstruation
• injuries/trauma to the kidneys or urinary tract
• taking certain medicines, like some over-the-counter pain relievers
• vigorous exercise (many athletes, especially distance runners, get hematuria from time to time)

In rare cases in children, hematuria can be a sign of kidney cancer or bladder cancer, a blood disease, or a blood clot. If something like that is going on, hematuria usually will be one of many other symptoms.

Very occasionally, what looks like hematuria might be something else. It’s possible for things like food dye, some foods (like beets or blackberries), or certain prescription medicines to make a person’s urine look red.

Signs & Symptoms

Technically speaking, hematuria is a symptom. Microscopic hematuria has no visible signs. Doctors will only know someone has it if a urine test finds it. Gross hematuria can be seen because it changes the color of urine, which can happen with just a little bit of blood. In many cases, red or tea-colored urine is the only symptom.

In more serious cases, hematuria can be just one of many symptoms of another condition. For instance, if a bladder infection is causing the hematuria, other symptoms might include fever, pain while peeing, and lower belly pain.

Diagnosis

If you ever see blood in your child’s urine, don’t panic. Chances are it’s no big deal. But you’ll want to make sure, so take your child to see a doctor. It’s important to find the cause in case any treatment is needed.

The doctor will do a physical exam and ask about symptoms, recent activities, and family medical history. Your child will give a urine sample for testing. If the urine test comes back negative, the doctor probably will do another test 1-2 weeks later, just to make sure the urine is free of red blood cells. Hematuria that only happens once won’t require any follow-up with the doctor.

If your child has microscopic hematuria with no other symptoms (like pain or fever) and no protein in the urine, the doctor will do more urine tests over a few months to see if there’s still blood in the urine.

If test results point to something more serious, or if your child has had a recent injury, more tests might be done. These can include a urine culture, or imaging tests like a kidney ultrasound, MRI, or CT scan that let doctors examine the urinary tract.

When to See a Specialist (Nephrologist)

Kids who have hematuria and protein in the urine should see a nephrologist (a doctor who specializes in kidney care). So should kids with microscopic hematuria that doesn’t go away after a few months, or who have microscopic hematuria and high blood pressure and other symptoms.

Additional testing can help find the cause of blood in the urine. Tests may include:

• blood tests to check kidney function
• urine tests to look for protein, calcium, and creatinine (a waste product found in urine)
• kidney ultrasound
• kidney biopsy (removing a tiny sample of tissue for testing)
• cystoscopy (a procedure done by a urologist, who uses a thin, tube-like instrument with a tiny camera on the end to see the inside of the urethra and bladder)

Treatment

Most of the time, hematuria doesn’t need any treatment. If it only happens once, it’s nothing to worry about.

Those who get blood in their urine more than once but have no other signs of illness may need urine tests and physical exams every few months for a year and then yearly after that as a precaution.

If another condition is causing the hematuria, doctors will treat that condition. For instance, hematuria that is due to a urinary tract infection (UTI) will be treated with antibiotics.

If your child has been treated for hematuria, the doctor probably will want to do follow-up tests to make sure your child’s urine is free of red blood cells.

The kidneys are fist-sized organs in the back that are shaped like kidney beans. They filter blood and help remove waste products from the body. Tiny filtering units within the kidneys do this with the help of blood vessels called glomeruli.

If the glomeruli get inflamed (swollen and irritated), it’s called glomerulonephritis (gluh-MARE-you-low-ne-FRY-tis). Glomerulonephritis causes the kidneys to stop working properly. This can lead to swelling (from too much fluid in the body) in places like the face, feet, ankles, or legs. Glomerulonephritis also can cause kidney failure and kidney disease, but that’s rare.

Glomerulonephritis can be acute (meaning it comes on suddenly) or chronic (developing over several months or years). Often, people don’t know they have glomerulonephritis until a routine urine test finds it. How it’s treated depends on which type a person has.

Most of the time, glomerulonephritis gets better on its own — and, if it doesn’t, there’s a lot that doctors can do to prevent further damage.

How the Kidneys Work

One of the main jobs of the kidneys is to filter the waste out of the blood. The body doesn’t use everything that we eat and drink, so some of it ends up in our blood as waste, along with other waste products that our bodies make naturally. The kidneys filter blood and remove these waste products and excess fluid, which then leave the body as urine (pee).

The blood filtering happens in tiny structures called nephrons. Each kidney has about a million nephrons. Each nephron has a glomerulus (the singular of glomeruli). The glomerulus, which is a ball of tiny blood vessels, is where the process of removing waste products and fluids from the blood begins. If the glomeruli aren’t doing their job properly, it can lead to health problems.

Causes

Causes of acute glomerulonephritis include:

• problem with the immune system or diseases that affect it (such as systemic lupus erythematosus or HIV)
• conditions that affect the blood vessels (like vasculitis or Henoch-Schönlein purpura)
• an infection with group A streptococci bacteria (the bacteria that cause strep throat)
• hepatitis

While acute glomerulonephritis has known causes, sometimes doctors don’t know why people get chronic glomerulonephritis. In rare cases, children can inherit glomerulonephritis from their parents; this is called Alport syndrome.

Symptoms

Early signs of glomerulonephritis include:

• blood in the urine (hematuria, which causes red or brown urine)
• protein in the urine, which can make urine appear foamy in the toilet
• swelling, especially in the morning, around the face, eyes, ankles, legs, and abdomen
• high blood pressure (hypertension)

With acute glomerulonephritis, symptoms come on suddenly, possibly after a skin infection or a case of strep throat. Chronic glomerulonephritis can take several months or years to develop and is found through a urine test.

If the condition isn’t caught early and treated, there’s a chance of kidney damage or failure. Symptoms of kidney failure include:

• peeing more often
• reduced amounts of urine
• lack of appetite
• nausea and vomiting
• weight loss
• muscle cramps at night
• fatigue (tiredness)
• pale skin
• high blood pressure
• headaches
• fluid buildup in the tissues

Someone who has these symptoms might not have kidney failure — many other things can cause them. But if your child has any of these problems, it’s important to see a doctor right away to find the cause.

Diagnosis

At the doctor’s office, explain your child’s symptoms. The doctor will examine your child and may draw a little blood and get a urine sample for testing. The doctor also might order a kidney ultrasound to get a better look at the kidneys. Ultrasounds use sound waves to create images of organs and other body parts.

In some cases, a biopsy may be done. During this procedure, a tiny sample of kidney tissue is removed and sent to a lab for testing to help find the cause of the glomerulonephritis and check for any kidney damage.

Treatment

Sometimes, acute glomerulonephritis gets better on its own. When treatment is needed, it’s best to start as soon as possible. That way there’s less chance of damage to the kidneys.

How doctors treat acute glomerulonephritis in kids depends on what’s causing it, what tests (like a kidney biopsy) show, how severe any kidney damage is (based on the biopsy results), what the symptoms are, and a child’s age and general health.

Treatment may include:

• fluid restriction (limiting the amount of fluid a child drinks per day)
• a diet low in protein, salt, and potassium
• diuretics (medicines that increase urine production)
• medicines to lower blood pressure (if high blood pressure is a problem)
• antibiotics (if a bacterial infection is causing glomerulonephritis)
• steroids and other drugs that suppress the immune system (if an immune system problem is causing it)
• in severe cases, kidney dialysis (a procedure that cleans the blood and removes fluids from the body)

In most cases of acute glomerulonephritis, the damage to the glomeruli will eventually heal. How long this takes depends on what caused the condition, how long it lasted, and when treatment began.

When someone doesn’t respond to treatment, glomerulonephritis can become chronic.

Chronic Glomerulonephritis

Chronic glomerulonephritis means one of two things:

1. Someone has had glomerulonephritis for many months or even years — the person may not have had any signs of a problem until the kidney was so injured that damage couldn’t be reversed.
2. Acute glomerulonephritis has become chronic because it didn’t respond to treatment.

There’s no specific way to treat chronic glomerulonephritis, so a doctor may recommend lifestyle changes to minimize further damage or slow down progression of the kidney disease.

Lifestyle changes that can help kids with chronic glomerulonephritis include:

• eating a healthy diet while limiting protein, potassium, phosphorus, and salt intake
• getting plenty of exercise (at least 1 hour a day for kids over age 2)
• drinking less fluids
• taking calcium supplements
• taking certain medicines

In rare cases, glomerulonephritis can lead to kidney failure that requires dialysis or a kidney transplant. Fortunately, most kids will never need those procedures and will be able to play sports, participate in favorite activities, and lead perfectly normal lives.

At first, Tyler developed red patches and raised spots that turned purple and looked like bruises all over his legs and buttocks. Then he complained that his stomach and knees hurt. When his parents took him to the doctor to find out what was wrong, the doctor said that Tyler had the classic signs of Henoch-Schönlein purpura.

About Henoch-Schönlein Purpura

Henoch-Schönlein purpura (HEH-nok SHOON-line PURR-puh-ruh) — usually just called HSP — is a condition that causes small blood vessels to become swollen and irritated. This inflammation, called vasculitis, usually occurs in the skin, intestines, and kidneys. Inflamed blood vessels in the skin can leak blood cells, causing a rash called purpura. Vessels in the intestines and kidneys also can swell and leak.

The condition was named after two German doctors, Eduard Henoch and Johann Schönlein, who first described the disease in the 1800s. Sometimes it’s also called allergic purpura, anaphylactoid purpura, or IgA vasculitis.

HSP occurs much more often in kids than in adults, usually between ages 3 and 10. It is one of the most common forms of vasculitis in children, and boys get it about twice as often as girls.

Causes

Although no one really knows what causes HSP, doctors do know that it occurs when the body’s immune system doesn’t function as it should. A protein called immunoglobulin A (IgA) is a type of antibody that works to fight infections. In HSP, IgA also gets placed in the blood vessels and causes swelling and bleeding.

It is unclear why this immune reaction occurs. It often happens after a bacterial or viral infection of the upper respiratory tract (sinuses, throat, or lungs). It is seen more often in fall, winter, and spring. Although less common, other possible triggers include certain medicines, food reactions, insect bites, and vaccinations.

HSP cannot be passed from one person to another.

Signs and Symptoms

Common signs and symptoms of HSP include:

• purpura, a raised, reddish purple rash
• joint pain and swelling
• stomach pain
• blood in the urine (pee) or other kidney problems
• fever
• headache

The rash occurs in all cases and is what helps doctors diagnose HSP. It may take the form of purpura, pinpoint red dots called petechiae, bruises, or sometimes blisters. The rash usually occurs on the legs and buttocks, but can also appear on other parts of the body, such as the elbows, arms, face, and trunk.

Most kids with HSP also have joint pain and swelling. These symptoms can happen before the rash appears. HSP most commonly affects the ankles and knees, but other joints like the hands, elbows, and feet may be affected.

Stomach pain usually starts a week after the rash appears. Pain may come and go and can be accompanied by nausea, vomiting, or diarrhea. Some kids will have blood in the stool (caused by leaky blood vessels), but it may not be visible.

HSP can affect the kidneys in some cases. Small amounts of blood or protein might be found in the urine, and the urine may look bloody.

Diagnosis

When the characteristic rash on the legs and buttocks is present, especially if accompanied by abdominal or joint pain, doctors can easily diagnose HSP. A diagnosis may be more difficult if joint pain or abdominal symptoms are present before the rash appears, or if symptoms take several weeks to show up.

The doctor also may request routine blood tests to look for signs of infections, anemia, or kidney disease. If abdominal pain is severe, imaging tests (like X-rays or ultrasound) may be needed. A stool sample can check for blood in the stool (poop). A urine sample can reveal blood or protein in the urine.

Up to half of kids who develop HSP will have problems with their kidneys, so the doctor will probably check kidney function over several months. If the doctor suspects that HSP has caused kidney damage, your child may need to see a kidney doctor (nephrologist).

Treatment

Symptoms of HSP usually last for about a month. Most of the time, it goes away on its own without treatment. To help your child feel better, the doctor may recommend certain medications, such as:

• antibiotics, if an infection is causing the HSP
• painkillers (such as acetaminophen)
• anti-inflammatory medicines (such as ibuprofen) to relieve joint pain and inflammation
• corticosteroids (such as prednisone) for severe abdominal pain or severe kidney disease

Also, the doctor may tell you to stop giving your child certain medications if there’s a chance that they caused the HSP.

While at home, try to keep your child as comfortable as possible. Be sure your child gets plenty of rest and drinks fluids. If your child stops eating or drinking, or develops severe abdominal pain or kidney problems, hospitalization might be necessary.

What to Expect

Most children with HSP fully recover within a month and have no long-term problems. Kids whose kidneys are affected will need to see a doctor for regular checkups to monitor kidney function.

About one-third of those who have HSP get it again, usually a few months after the first episode. If HSP does come back, it’s usually less severe than the initial episode.

The kidneys play a critical role in the body: Acting as the body’s filtering system, they help control water levels and eliminate wastes through urine (pee). They also help regulate blood pressure, red blood cell production, and the levels of calcium and minerals.

But sometimes the kidneys don’t develop properly and, as a result, don’t function as they should. Often these problems are genetic and not due to anything a parent did or didn’t do.

Many of these problems can be diagnosed before a baby is born through routine prenatal testing and treated with medication or surgery while the child is still young. Other problems may appear later, with symptoms such as urinary tract infections (UTIs), growth problems, or high blood pressure (hypertension).

In some cases, the problems can be severe and require surgical treatment.

How the Kidneys Work

The kidneys are like the body’s garbage collection and disposal system. Through microscopic units called nephrons, the kidneys remove waste products and extra water from the food a person eats, returning chemicals the body needs (such as sodium, phosphorus, and potassium) back into the bloodstream. The extra water combines with other waste to become urine, which flows through thin tubes called ureters to the bladder, where it stays until it exits through the urethra (the tube that carries urine out of the body from the bladder) when someone goes to the bathroom.

The kidneys also produce three important hormones: erythropoietin, which stimulates the bone marrow to make red blood cells; renin, which helps regulate blood pressure; and the active form of vitamin D, which helps control the calcium balance in the body and maintain healthy bones.

Kidney failure, which is also called renal failure, is when the kidneys slow down or stop properly filtering wastes from the body, which can cause buildups of waste products and toxic substances in the blood. Kidney failure can be acute (sudden) or chronic (happening over time and usually long lasting or permanent).

• Acute kidney injury (sometimes called acute kidney failure) may be due to bacterial infection, injury, shock, heart failure, poisoning, or drug overdose. Treatment includes correcting the problem that led to the kidney injury and, in some cases, dialysis .
• Chronic kidney failure involves a deterioration of kidney function over time. In kids and teens, it can result from acute kidney failure that fails to improve, birth defects, chronic kidney diseases, or chronic severe high blood pressure. If diagnosed early, chronic kidney failure can be treated. The goal of treatment usually is to slow the decline of kidney function with medication, blood pressure control, and diet. At some point, a kidney transplant may be needed.

Childhood Kidney Diseases

The most common kidney diseases in children are present at birth. They include:

Posterior urethral valve obstruction: This narrowing or obstruction of the urethra affects only boys. It can be diagnosed before the baby is born or just after and is treated with surgery.

Fetal hydronephrosis: This enlargement of one or both of the kidneys is caused by either an obstruction in the developing urinary tract or a condition called vesicoureteral reflux (VUR) in which urine abnormally flows backward (or refluxes) from the bladder into the ureters. Fetal hydronephrosis is usually diagnosed before the child is born and treatment varies widely. In some cases the condition only requires ongoing monitoring; in others, surgery must be done to clear the obstruction from the urinary tract.

Polycystic kidney disease (PKD): This is a condition in which many fluid-filled cysts develop in both kidneys. The cysts can multiply so much and grow so large that they lead to kidney failure. Most forms of PKD are inherited. Doctors can diagnose it before or after the child is born. In some cases, there are no symptoms; in others, PKD can lead to UTIs, kidney stones, and high blood pressure. Treatment for PKD varies — some cases can be managed with dietary changes; others require a kidney transplant or dialysis.

Multicystic kidney disease (MKD): This is when large cysts develop in a kidney that hasn’t developed properly, eventually causing it to stop working. (While PKD always affects both kidneys, MKD usually affects just one kidney.) Fortunately, the unaffected kidney takes over and most people with MKD will have normal kidney function. MKD usually is diagnosed by prenatal ultrasound before birth. Doctors manage it by monitoring blood pressure and screening for UTIs when needed. Very rarely, surgical removal of the kidney might be necessary.

Renal tubular acidosis: This is when the kidneys do not properly control the amount of acid in the body. It can cause kidney stones and affect a child’s growth, but usually can be treated with medications.

Wilms tumor: This type of childhood cancer involves the kidney, and usually is diagnosed within the first 2 years of life. It can be treated with surgery and chemotherapy.

Glomerulonephritis: This is an inflammation or infection of the glomeruli, which are parts of the nephrons that contain tiny blood vessels. It can affect the kidney’s ability to filter waste and can lead to swelling, blood in the urine, and a reduction in urine production. Some cases can be treated with medication, while others require dialysis or a kidney transplant.

Nephrotic syndrome: This is when the body loses large amounts of protein through the urine, usually because of a change in the nephrons. Most cases are diagnosed after a child is a year old. Swelling of the face, abdomen, and extremities are among the main symptoms, and are often relieved with medication.

Congenital problems with the urinary tract: As a baby develops in the womb, part of the urinary tract can grow to an abnormal size or in an abnormal shape or position. These problems include:

• duplication of the ureters, in which a kidney has two ureters instead of one. This can lead to urinary tract infections over time and can be treated with medication or, in some cases, with surgery.
• horseshoe kidney, where the two kidneys are fused (connected) into one arched kidney that usually functions normally, but is more prone to develop problems later in life. An uncomplicated horseshoe kidney does not need medical or surgical treatment, but it does need to be checked regularly by doctors.

Other Problems With the Kidneys

Sometimes a child can have other health problems that affect how well the kidneys function. These can include:

High blood pressure (hypertension): The kidneys control blood pressure by regulating the amount of salt in the body and by making the enzyme renin that, along with other substances, controls the constriction of blood vessels. The many causes of high blood pressure include any of the kidney diseases mentioned above; genetic factors such as the so-called “essential hypertension,” which is the most common form of high blood pressure in adults; and obesity, which has become a major factor.

Kidney stones: The result of the build-up of crystallized salts and minerals such as calcium in the urinary tract, kidney stones (also called calculi) also can form after an infection. Kidney stones that are large enough to block the kidney or ureter can cause severe abdominal pain. But most stones usually pass through the urinary tract on their own. In some cases, they need to be removed surgically, or treated with medication or modifications to the diet. Sometimes the first symptoms are pain and blood in the urine. Kidney stones are more common in adults than in kids.

Nephritis. This is any inflammation of the kidney. It can be caused by infection, an autoimmune disease (such as lupus), or an unknown reason. The first symptoms of nephritis usually are high levels of protein and blood in the urine.

Urinary tract infections (UTIs). UTIs are usually caused by bacteria, such as E. coli. Most UTIs occur in the lower urinary tract (in the bladder and urethra) and can cause pain during urination and a fever. Antibiotic treatment should begin as soon as possible so the infection doesn’t spread to the kidneys, where it can cause irreversible damage. In babies, UTIs tend to be more common in boys than girls, perhaps because boys are more affected by congenital kidney problems that increase their risk of infection. Later in life, girls are more likely to get UTIs because of their shorter urethras. Bad habits can contribute to UTIs — kids holding it when they need to go to the bathroom, or wiping themselves in the wrong direction after using the toilet (they should wipe from front to back so bacteria from the stool do not get into the urethra). Among teens, girls are more likely to develop UTIs than boys, mostly due to the shorter urethra or sexual activity with a full bladder.

Symptoms of Kidney Problems

The signs and symptoms of urinary tract or kidney problems vary and include:

• fever
• swelling around the eyes, face, feet, and ankles (called edema)
• burning or pain during peeing
• significant increase in the frequency of urination
• difficulty in controlling urination in kids who are mature enough to use the toilet
• recurrence of nighttime bedwetting (in kids who have been dry for several months)
• blood in the urine
• high blood pressure

Diagnosis of Kidney Diseases

If a kidney disease is suspected, the doctor will take a medical history, do a physical exam, and order urine tests, blood tests, imaging studies, or a biopsy to help make a diagnosis. These studies are usually suggested by a nephrologist, a doctor who specializes in the diagnosis and treatment of kidney diseases.

With urinalysis (a type of urine test), the doctor can quickly detect abnormalities (such as too many red blood cells) that may signal inflammation or irritation in the urinary tract. Urinalysis can also detect an of excess white blood cells, which is most commonly associated with bladder and kidney infections.

Certain blood tests tell doctors how well the kidneys are filtering waste products and balancing the bloodstream’s chemical makeup.

Two other important diagnostic tools doctors use are blood pressure and growth measurements. Along with the heart, the kidneys are crucial to determining blood pressure. High blood pressure in a child is an important sign that the kidneys need to be evaluated. Accurate growth measurements can provide a clue to diagnosing some kidney diseases because kids with chronic kidney disease often have growth problems.

The doctor may use a kidney biopsy to evaluate kidney function. A biopsy is a procedure in which a small piece of the kidney tissue is removed with a needle. Performed while a child is under anesthesia, it’s a simple procedure that can help make an accurate diagnosis of the kidney problem in about 9 out of 10 cases. It’s especially helpful in the diagnosis of nephritis and nephrosis.

In addition to standard X-rays, other imaging studies a doctor may use to help diagnose kidney diseases include:

Ultrasound

The most commonly used imaging study, an ultrasound is painless and requires no X-ray exposure or special preparation. A renal ultrasound shows details of the anatomy of the kidneys and bladder. It can rule out or diagnose obstructions, developmental abnormalities, tumors, and stones in the kidneys and urinary tract.

Computerized tomography (CAT) scan

A CAT scan is often helpful in revealing the anatomy of the kidneys or bladder and, in some cases, is better than ultrasound for finding kidney stones. It can show if the kidneys have developed properly or if the flow of urine is blocked by a stone or a developmental abnormality.

Renal nuclear scan

A renal nuclear scan involves having special radioactive material injected into a vein. The radiation dose is less than that of a simple X-ray. The scan shows how the kidneys compare with each other in size, shape, and function. It also can detect scarring or other evidence of recurrent or chronic kidney infection.

Voiding cystourethrogram (VCUG)

VCUG is commonly used to evaluate the bladder and the ureters. This procedure involves putting a dye into the bladder to see whether there’s an obstruction or a reflux of urine from the bladder back up to the kidneys when the child urinates.

Kidney stones are small, solid masses that can develop in the urinary tract. Also called calculi or nephrolithiasis, kidney stones are made when salts and minerals in urine (pee) become extra concentrated and then become crystals. Over a few weeks or months, the crystals can build up and become stones.

Kidney stones range in size from a fraction of an inch to several inches. Small kidney stones (0.2 inches or less than 5 mm) can pass through the urinary tract and out of the body with little or no pain, but larger stones can be quite painful, block the flow of urine, and cause blood in the urine and other symptoms. In some cases, kidney stones can lead to problems with the kidneys and urinary tract. Most kidney stones, however, cause no permanent damage.

Although they mostly affect adults, kids can get kidney stones. There are different types of kidney stones with many different causes, with most types more common in boys than girls.

Treatment depends on the type of stones and their size. Some kids just need to drink a lot of water and take pain medicines to pass a kidney stone. Those with larger stones may need surgery or other treatments to help remove the stones.

How Kidney Stones Form

It’s the kidneys’ job to remove excess fluids and waste products from the blood and pass them through the urinary tract and out of the body as urine (pee). Urine contains substances — such as calcium, oxalate, phosphate, citrate, cystine, and uric acid — that in large amounts can crystallize and form kidney stones.

Usually, these substances are very diluted in the urine. But if urine becomes concentrated or something changes the level of a substance in it, crystals can form. The crystals can become lodged in the kidney and grow to become kidney stones.

Types of Kidney Stones

The four major types of kidney stones are:

1. Calcium stones: The most common kind of kidney stone, these develop when calcium in the urine combines with other substances to form crystals.
2. Cystine stones: These are rare and form when there is too much cystine (an amino acid) in the urine.
3. Uric acid stones: These form when there is too much uric acid in the urine. Uric acid can crystallize by itself or combine with calcium to form a stone.
4. Struvite stones: Also called staghorn calculi because they can look like a stag’s antlers, these are made of a mineral called struvite that consists of ammonium, magnesium, and phosphate. Struvite stones almost always are due to an infection of the kidneys or urinary tract. More common in females, these can grow rather large and be more harmful to the kidneys than other stones.

Causes

Kidney stones are more common in adults, but premature babies, kids, and teens can still get them. Most kids who develop them have a health condition that increases their risk for kidney stones. Others get them for unknown reasons.

Some types of kidney stones run in families, so having a relative with kidney stones can make a person more likely to get them. Kids who have had kidney stones before are more likely to get them again.

Other risk factors include:

• Dehydration. Not drinking enough fluids can cause urine to become extra-concentrated. This increases the chance of crystals forming.
• An unhealthy diet and lifestyle. Drinking lots of sugary, caffeinated, or sports drinks and eating a diet high in sodium (salt) can increase the risk of calcium stones. Obesity also can make kids more likely to get them.
• Urinary tract defects. A structural defect in the urinary tract can block the flow of pee and create an area where it collects in a tiny pool. When pee stops flowing, crystal-forming substances may settle together and form stones.
• Taking certain medicines. Some prescription and over-the-counter medicines can increase the risk of kidney stones if taken in large doses.
• Metabolic disorders. Having a metabolic disorder (a problem in the way the body breaks down and uses food) can lead to concentrated levels of oxalate (a substance made in the body and found in some foods) or cystine in the urine.
• Cystinuria. This genetic condition causes too much cystine to pass from the kidneys into the urine, causing cystine stones to form.
• Other medical conditions. A number of diseases and conditions can increase the risk of kidney stones, including gout (a type of arthritis), other kidney diseases, conditions that affect the thyroid or parathyroid gland, and some urinary tract infections (UTIs).

Signs & Symptoms

Usually, kids with kidney stones won’t have any symptoms until the stones move around in the kidney or pass into the ureter. Small stones might pass through the urinary tract and out of the body with no pain or complications.

Larger stones, however, may block the urinary tract and can cause symptoms like:

• sharp pain that starts in the side or back
• pain that spreads to the lower abdomen and groin as stones move through the urinary tract
• pain that comes and goes in waves
• blood in the urine (red or brown urine), called hematuria
• nausea and vomiting
• needing to pee often or urgently
• fever or chills

A stone that’s too large to move can sometimes create a backup of urine, causing one or both kidneys to swell (this is called hydronephrosis). Hydronephrosis can cause pain in the side and back. If it’s not treated, it may cause long-term damage to the kidney.

Diagnosis

If your child has pain in the side, blood in the urine, or any other symptoms of kidney stones, see a doctor as soon as possible. If your child has pain along with nausea, vomiting, fever, or chills, or is having trouble peeing, go to an emergency clinic or hospital emergency room right away.

To make a diagnosis of kidney stones, the doctor will ask about the symptoms and how long they’ve been going on; your child’s diet; factors that could be causing dehydration; any family history of kidney stones; and any history of diseases or conditions that can affect the kidneys or urinary tract.

The doctor will do a physical exam and probably order blood tests, urine tests, or kidney function tests to look for kidney stones. Imaging tests (such as ultrasounds, X-rays, or CT scans) are often used to get a better look at the kidneys. If there is a stone, an imaging test can show its exact size and location, which will help doctors decide on the best treatment.

Treatment

Treatment for kidney stones depends on the type of stones, what’s causing them, and how severe the symptoms are. Small stones usually pass on their own and don’t need much treatment, but large stones may need surgery or another procedure to help remove them.

To help pass a small stone, give your child plenty of water to drink and medicine to ease the pain. Often, over-the-counter medicines such as ibuprofen and acetaminophen are enough, but some cases may require prescription pain medicines. The doctor also may ask you to strain your child’s urine for a few days to collect the passed kidney stones. Examining the stones can help the doctor decide on the best treatment.

Kidney stones that block the urinary tract or cause severe pain or dehydration may require a hospital visit. In the hospital, a child may be given intravenous (IV) fluids and pain medicine to help stones pass and treat or prevent dehydration.

Large stones rarely pass on their own and usually need some treatment. To get rid of large stones and stones that are damaging the kidneys, doctors might use:

• Extracorporeal shock-wave lithotripsy. This treatment uses sound or shock waves to break kidney stones into smaller pieces that can be passed out of the body in urine.
• Ureteroscopic stone removal. A ureteroscope is a small tube with a camera at the end. In this procedure, doctors give the patient anesthesia, then thread the tube into the urethra through to the bladder. The tube is then threaded to the ureter and into the kidney until the stone is found. The ureteroscope has special tools that can remove the stone from the urinary tract or break it into smaller pieces.
• Percutaneous nephrolithotomy. This technique is used for large stones in or near the kidneys. A tube called an endoscope is inserted into the kidney through a small surgical cut in the back and used to remove the stone. For large stones, an ultrasonic probe may be needed to deliver shock waves that break the stone into small pieces that can be removed more easily. People often stay in the hospital for a couple of days after kidney stone surgery.
• In rare cases, if any of the above techniques don’t work, a type of open surgery called nephrolithotomy may be done to remove large stones. This involves making a cut or incision in the side to gain access to the kidney. X-rays taken during this procedure help surgeons locate the kidney stone. Then, it is removed and sent to a lab for testing.

Outlook

Doctors will want to monitor kids who have had kidney stones to prevent new ones from forming. Your child’s doctor might have you use a 24-hour urine collection test, which measures the volume of urine your child pees out within a 24-hour period and evaluates the substances in it.

Depending on the type of kidney stone your child had, doctors can prescribe treatments or medicines to reduce the levels of crystal-forming substances in the urine.

Prevention

While it’s not always possible to prevent some types of kidney stones, drinking enough water to avoid dehydration is important. When pee is almost clear, it’s a sign that a person is getting enough fluids. Cutting back on salt and salty foods also helps lower the risk of kidney stones.

To help prevent new stones from forming, all kids who’ve had kidney stones should:

• drink a lot of fluids throughout the day. This can mean anywhere from 3 cups a day (for infants) to 8 cups a day (for teens). Ask your doctor how much your child should drink.
• limit the amounts of salt and protein in their diet
• limit consumption of soda/soft/sports drinks

If dietary changes fail to prevent kidney stones, drug therapy might be helpful. A number of drugs are available to lower the levels of crystal-forming substances in the urine and prevent kidney stones.

Kids with too much protein in their urine (pee), sudden weight gain, and swelling in various body parts could have something called nephrotic syndrome.

Nephrotic syndrome happens when tiny structures in the kidneys called glomeruli (gluh-MARE-you-lie) stop working properly and let too much protein enter the kidneys. In kids, this is usually due to a kidney condition called minimal change disease that affects the glomeruli. Nephrotic syndrome is more common in boys than girls, especially in kids younger than age 5.

Fortunately, most cases (including those caused by minimal change disease) can be effectively treated with medicine. Most kids who get nephrotic syndrome as a result of minimal change disease eventually outgrow it by the teen years.

How the Kidneys Work

The kidneys are a pair of bean-shaped organs located toward the back of the abdominal cavity, just above the waist. The kidneys remove waste products and extra water from the food a person eats, returning chemicals the body needs (such as sodium, phosphorus, and potassium) back into the bloodstream. The extra water combines with other waste to become urine (pee).

The main functional units of the kidneys, where the blood filtering happens, are tiny organs called nephrons. Each kidney has about a million nephrons, and each nephron has one glomerulus (singular of glomeruli) — a ball of tiny blood vessels, or capillaries. The glomerulus is the nephron’s filter. This is where the process of removing waste products and fluids from the blood begins.

When the glomeruli stop filtering properly, they allow too much protein to leave the blood. Protein helps hold fluids in the blood, so when there is less protein in the blood, the fluids can move to other parts of the body and cause a type of swelling (edema) in the face, belly, hands, arms, and other extremities. When this happens, it’s called nephrotic syndrome.

Causes

A number of conditions can damage the glomeruli and cause nephrotic syndrome. But in kids it’s usually due to minimal change disease. With minimal change disease, the glomeruli don’t appear to be affected when viewed under a regular microscope. That’s why the condition gets the name “minimal change.” The changes to the glomeruli can only be seen under an electron microscope.

The cause of minimal change disease isn’t known, but it can be related to infections, tumors, allergic reactions, and excessive use of over-the-counter medications like ibuprofen and acetaminophen. Fortunately, most kids outgrow minimal change disease by the time they’re in their teens.

Other conditions can damage the glomeruli, including other kidney conditions, immune system problems, infections, or diseases like cancer and diabetes. In certain cases, an allergic reaction to food or a bee sting, the use of certain legal and illegal drugs, or morbid obesity can lead to nephrotic syndrome.

Symptoms

Some kids have no obvious symptoms of nephrotic syndrome and don’t know they have the condition until after it’s been diagnosed through a urine test.

When symptoms do appear, swelling and weight gain tend to be the most common. Swelling happens as excess fluids and salt build up in the body. Often, this can be enough to bring on a rapid, unintentional increase in weight.

The most common places for swelling are:

• in the face, especially around the eyes
• in the abdomen (belly)
• in the arms and legs, particularly around the ankles and feet

Some kids with nephrotic syndrome notice swelling around their ankles after they’ve been standing or sitting for a long time. Others may notice more swelling around their eyes first thing in the morning. Other common signs include loss of appetite, diarrhea, less frequent urination, and urine that looks dark and foamy.

In rare cases, the condition causing nephrotic syndrome can lead to other symptoms and complications, like kidney damage with kidney failure, thrombosis (blood clots in the blood vessels), or infection due to a loss of proteins that help fight infections.

Diagnosis

If your child has symptoms of nephrotic syndrome, see a doctor. The doctor will probably ask your child for a urine sample to check for too much protein. The doctor also might take a small blood sample for testing.

If the tests indicate that your child has nephrotic syndrome, the doctor will determine what the underlying cause is and then decide on how best to treat it. This may require your child to undergo additional blood tests. In rare cases, the doctor may need a tiny sample of kidney tissue to test for specific causes of nephrotic syndrome. This is known as a kidney biopsy.

Treatment

Nephrotic syndrome is almost always treatable, but the treatment depends on the cause. To treat minimal change disease, doctors usually prescribe a medicine called prednisone. One of prednisone’s functions is to suppress the body’s immune system, which can help the glomeruli work the way they’re supposed to.

Prednisone is very effective at treating nephrotic syndrome, but it can sometimes have side effects. Doctors often prescribe additional medicines to ease or suppress side effects when someone takes prednisone.

In some cases, nephrotic syndrome does not respond to prednisone. When this happens, the doctor may want to do a kidney biopsy to determine the cause. Other causes of nephrotic syndrome may be treated by other medicines or therapies.

When kids have nephrotic syndrome, doctors may prescribe a medicine called a diuretic to help them pee more often. This can help control the swelling in the body until protein levels in the blood return to normal.

At home, kids should eat a low-salt diet to help reduce swelling. Reducing the amount of protein in a child’s diet is not necessary. For other dietary suggestions, talk to a doctor or nutritionist.

Outlook

Fortunately, in most kids with nephrotic syndrome the condition goes away for good by the time they’re teens and doesn’t damage the kidneys. In the meantime, kids might need to take medicines for a few months or more.

Sometimes, a child will have a relapse — where the nephrotic syndrome comes back after going away. In that case, treatment would begin again until the child outgrows the condition or it improves on its own.

About UTIs

Urinary tract infections (UTIs) are common in kids, especially girls and uncircumcised boys. In fact, by age 5, about 8% of girls and 1%–2% of boys have had at least one UTI.

UTIs happen when the kidneys, ureters, bladder, or urethra become infected. Symptoms of a UTI can include:

• pain when urinating
• changes in frequency of urination
• changes in appearance or smell of urine
• fever
• chills
• loss of appetite
• nausea
• vomiting
• lower abdominal pain
• lower back pain or discomfort

UTIs also can cause kids to wet their pants or the bed, even if they haven’t had these problems before. Infants and very young children may only show nonspecific signs, such as fever, vomiting, or decreased appetite or activity.

Some kids get UTIs again and again — these are called recurrent UTIs. If not treated, recurrent UTIs can cause kidney damage, especially in kids younger than 6. So it’s important to know how to recognize the signs of these infections and get help for your child.

Types of UTIs

Common types of UTIs include:

• cystitis: this bladder infection is the most common type of UTI. Cystitis occurs when bacteria move up the urethra (the tube-like structure that allows urine to exit the body from the bladder) and into the bladder
• urethritis: when bacteria infect the urethra
• pyelonephritis: a kidney infection caused by infected urine flowing backward from the bladder into the kidneys or an infection in the bloodstream reaching the kidneys

Related Conditions

Recurrent UTIs sometimes happen along with other conditions, such as:

• vesicoureteral reflux (VUR), which is found in 30%–50% of kids diagnosed with a UTI and is a congenital (present at birth) condition in which urine flows backward from the bladder to the ureters. Ureters are thin, tube-like structures that carry pee from the kidney to the bladder. Sometimes the pee backs up to the kidneys and if it is infected with bacteria, can lead to pyelonephritis.
• hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow and is usually caused by severe VUR or a blocked ureter. Kids with hydronephrosis are sometimes at risk of recurrent UTIs and may need to take daily low doses of antibiotics to prevent UTIs until the condition producing hydronephrosis gets better or is fixed through surgery.

But not all cases of recurrent UTIs can be traced back to these body structure-related abnormalities. For example, dysfunctional voiding — when a child doesn’t relax the muscles properly while urinating — is a common cause of UTIs. Infrequent urination (not peeing often enough) also can also increase a child’s risk for recurrent infections. Both dysfunctional voiding and infrequent urination can be associated with constipation.

Unrelated conditions that harm the body’s natural defenses, such as diseases of the immune system, also can lead to recurrent UTIs, although this is rare. In addition, use of a nonsterile urinary catheter can introduce bacteria into the urinary tract and cause an infection.

Detecting Abnormalities

Although UTIs can be treated with antibiotics, it’s important for a doctor to rule out any underlying abnormalities in the urinary system when UTIs happen repeatedly. Kids with recurrent infections should see a pediatric urologist to see what is causing the infections.

Some abnormalities can be found even before birth. Hydronephrosis that develops before birth can be detected in a fetus by ultrasound as early as 16 weeks of gestation. In rare cases, doctors may consider neonatal surgery (performing surgery on an unborn baby) if hydronephrosis affects both kidneys and poses a risk to the developing fetus. Most of the time, though, doctors wait until after birth to treat the condition, because almost half of all cases diagnosed prenatally disappear by the time a baby is born.

Once a baby suspected to have hydronephrosis or another urinary system abnormality is born, the baby’s blood pressure will be monitored carefully, because some kidney abnormalities can cause high blood pressure. An ultrasound may be used again to get a closer look at the bladder and kidneys. If the condition appears to be affecting both kidneys, doctors usually will order blood tests to measure kidney function.

Diagnosis

If an abnormality of the urinary tract is suspected, doctors might order tests to make an accurate diagnosis, including:

Ultrasound
Using high-frequency sound waves to “echo,” or bounce, off the body and create a picture of it, an ultrasound can detect some abnormalities in the kidneys, ureters, and bladder. It can also measure the size and shape of the kidneys.

When an ultrasound points to VUR or hydronephrosis, a renal scan or voiding cystourethrogram (VCUG) might give doctors a better idea of what’s going on.

Renal scan (nuclear scan)
Radioactive material is injected into a vein and followed through the urinary tract. The material can show the shape of the kidneys, how well they function, if there is damaged kidney tissue, and the course of the urine. A small amount of radiation is received during the test and leaves the body in the urine.

Voiding cystourethrogram (VCUG or cystogram)
A catheter (a hollow, soft tube) is used to inject an opaque dye into the bladder. This X-ray test can diagnose VUR and identify problems with the bladder or urethra.

Cystoscopy
A cystoscope uses lenses and a light source within a tube inserted through the urethra to directly view the inside of the bladder. It’s used when other tests or symptoms indicate a possible bladder abnormality.

Intravenous pyelogram
Opaque dye is injected into a vein, and then X-rays are taken to follow the course of the dye through the urinary system. Although this test is still used sometimes, the renal MRI and renal scan have replaced intravenous pyelogram in most cases.

Magnetic resonance urography (MR-U)
This procedure, which makes a magnetic resonance imaging (MRI) scan of the urinary tract without the use of dyes or radioactive materials, has been shown to be as accurate as other scans and is now typically done in place of an intravenous pyelogram.

Treatment

Treatment for recurrent UTIs depends on what’s causing them in the first place. Sometimes the answer is as simple as teaching a child to empty the bladder as soon as he or she has the urge to go.

If a condition like VUR is causing the infections, then the solution is a bit more complicated. Kids with VUR must be monitored closely, because the condition can lead to kidney infection (pyelonephritis) and subsequent kidney damage. Usually, surgery isn’t necessary, because many kids outgrow the condition.

Some kids with VUR benefit from daily treatment with a small amount of antibiotics, which can also make surgery unnecessary. Kids with VUR should be examined by a pediatric urologist to decide if antibiotic treatment is the best option for them.

In some cases, surgery is necessary to correct VUR. The most common type of surgery used is ureteral reimplantation, in which one or both of the ureters are repositioned to correct the backflow of urine from the bladder. The procedure can be done through a small incision. The success rate for this surgery is high, although not everyone is a good candidate for surgery.

Kids with the following situations may be candidates for ureteral reimplantation:

• intolerance to antibiotics
• recurrent infections while on antibiotic treatment
• severe, or “high-grade,” reflux
• older kids and teens with reflux

An alternative to ureteral reimplantation is endoscopic injection of a material to block the entry of the ureter into the bladder and prevent VUR. In this procedure, a narrow tube called an endoscope is inserted through the urethra into the bladder. The endoscope has a tiny camera at the tip, allowing the surgeon to guide it to the proper location and inject the material, which helps keep urine from refluxing back into the kidneys. Endoscopic injection is less invasive than surgery, but the results are not as good. A pediatric urologist can help families decide the best treatment for a child with VUR.

Kids who have recurrent infections that are not caused by anatomical defects or other treatable problems may be prescribed antibiotics for months or even years to prevent recurrent infections. This form of treatment is known as continuous antibiotic prophylaxis.

The Future for Managing Recurrent UTIs

Recent studies have found that women and kids who get recurrent UTIs may lack certain immunoglobins (a group of proteins that fight infections). Some researchers are optimistic that a vaccine may be developed to help boost production of antibodies that fight UTIs. A promising vaccine that would protect against E. coli (the most common bacterium that causes UTIs) is being tested.

Home Treatment

Additional things to consider to help prevent recurrent UTIs in kids:

Diet Modifications
Encourage kids to drink 8 to 10 glasses of water and other fluids per day. Cranberry juice and cranberry extract are often suggested because they may prevent E. coli from attaching to the walls of the bladder. Always ask your doctor, though, if your child should drink cranberry juice or cranberry extract, because they can interfere with some medicines.

Good Bathroom Habits
Frequent emptying of the bladder, normal urination and prevention of constipation can all help to prevent recurrent infections.

Multivitamins
Vitamin C acidifies the urine, making the environment less friendly to bacteria. Vitamins designed for kids are generally safe, but always ask your doctor before increasing the dose beyond the currently recommended daily allowance.

No Bubble Baths
Kids should avoid bubble baths and perfumed soaps because they can irritate the urethra.

Frequent Diaper Changes
Kids in diapers should be changed frequently to prevent stool from having prolonged contact with the genital area, which can increase the chance that bacteria will move up the urethra and into the bladder.

Proper Wiping Technique
In females, wiping from front to back after using the toilet will reduce exposure of the urethra to UTI-causing bacteria in the stool.

Cotton Underwear
Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.

Frequent Bathroom Visits
Some kids may object to using the school bathroom or may become so engrossed in a project that they delay urination. Kids with UTIs should pee at least every 3 to 4 hours to help flush bacteria from the urinary tract.

When to Call the Doctor

As soon as you suspect that your child has a UTI, it’s important to contact your doctor. The doctor may recommend another urine culture after treatment to be sure that the infection has cleared.

If your child suffers from recurrent UTIs, consult a pediatric urologist, who can perform a thorough evaluation and, if necessary, order tests for urinary system abnormalities. In the meantime, follow your doctor’s instructions for treating a UTI.

Each time our internal organs do something, such as digesting food or healing damaged tissue, chemical reactions take place in the body’s cells. These reactions cause acid to go into the bloodstream.

Normally, the kidneys remove excess acid from blood, but certain diseases, genetic defects, or drugs can damage a kidney’s ability to do this important job. This can allow too much acid to build up in the blood and cause problems. When this happens, it’s called renal tubular acidosis (RTA).

Without treatment, RTA can affect a child’s growth and cause kidney stones, fatigue, muscle weakness, and other symptoms. Over time, untreated acidosis can lead to long-term problems like bone disease, kidney disease, and kidney failure.

Fortunately, such complications are rare, since most cases of RTA can be effectively treated with medicines or by treating the condition that’s causing the acid to build up.

How the Kidneys Work

The kidneys are a pair of bean-shaped organs located toward the back of the abdominal cavity, just above the waist. The kidneys remove waste products and extra water from the food a person eats, returning chemicals the body needs (such as sodium, phosphorus, and potassium) back into the bloodstream. The extra water combines with other waste to become urine (pee).

The main functional units of the kidneys, where the blood filtering happens, are tiny structures called nephrons. Each kidney has about a million nephrons, and each nephron has a renal tubule, a tube where the acid and waste products filtered from the blood are secreted into urine.

Having a disease or defect can interfere with how the renal tubules function, which can lead to RTA.

Causes

There are a few different kinds of RTA. The first two types are named for the part of the renal tubule in which the damage or defect is found.

• Type 1 RTA, or distal renal tubular acidosis, is the most common kind of RTA. Distal means that the defect is relatively far from the beginning of the tubule. Distal RTA can be inherited or caused by high blood calcium, sickle cell disease, autoimmune disorders like lupus and Sjogren syndrome, or the use of certain drugs.
• Type 2 RTA, or proximal renal tubular acidosis, happens when the damage or defect is relatively close to the start of the tubule. Proximal RTA mostly happens in infants and usually is related to a disorder called Fanconi’s syndrome. Vitamin D deficiency, fructose intolerance, the use of certain drugs, and some diseases also can cause proximal RTA.
• Type 3 RTA is a combination of distal RTA and proximal RTA and is rarely used as a classification anymore.
• Type 4 RTA, or hyperkalemic renal tubular acidosis, is caused by a transport disorder in the distal tubule. Transport involves the movement of electrolytes such as sodium, chloride, and potassium between the blood and body parts. When this process is abnormal, it can cause too much potassium to build up in the blood (hyperkalemia). This can be a problem for the heart and other organs. Hyperkalemic RTA can be caused by urinary tract infections (UTIs), autoimmune disorders, sickle cell disease, diabetes, kidney transplant rejection, or the use of certain drugs.

Symptoms

A lot of the time, kids with RTA don’t have any symptoms and may not know they have the disease until it shows up on a blood or urine test.

For some kids, the first symptom of RTA is kidney stones, which can cause symptoms like:

• pain in the back or side that spreads to the lower abdomen
• pain while urinating
• pee that is red, brown, or cloudy
• frequent urge to urinate
• nausea and vomiting

Over time, RTA can affect bone development and keep a child from growing as much as he or she should. This is often why doctors suspect RTA in the first place.

Other symptoms of RTA you might notice include:

• confusion, decreased alertness, or fatigue
• increased breathing and heart rates
• decreased urination
• muscle weakness
• muscle cramps and pain in the back and abdomen
• rickets (a disorder that can cause bone pain and skeletal and dental deformities)

Diagnosis

If your child shows any symptoms of RTA, see a doctor right away. The sooner something is done about the condition, the more effective treatment will be.

To diagnose RTA, the doctor will do a physical examination and take a sample of your child’s blood for testing. He or she also may want a urine sample. If test results suggest that your child might have RTA, the doctor will work with you to decide the best way to treat it.

Treatment

How RTA is treated depends on what’s causing it. If it’s a reaction to a certain drug, treatment may involve stopping use of the drug or changing the dosage. If an underlying disease or other condition is causing RTA, it will be treated until that condition resolves.

To treat the effects of RTA, it’s necessary to restore a normal acid level to the blood. To do this, doctors prescribe alkaline medicines, such as sodium bicarbonate, that help to lower the blood’s concentration of acid.

Most of the time, treatment for RTA is effective. Kids whose RTA is caused by a genetic defect may need treatment for the rest of their lives. The good news is that sticking with their treatments lets kids remain healthy.

For most boys, talking seriously about their private parts can be a little embarrassing. And for teen boys, the topic is strictly off-limits — especially in front of their moms. But if you have a son, it’s important that he knows to tell you or a health care provider if he ever has genital pain, especially in his scrotum or testes.

Genital pain is usually nothing more than a mild, brief discomfort. But when it’s more painful, it can be caused by a very serious condition called testicular torsion. Testicular torsion is a medical emergency that usually requires immediate surgery to save the testicle.

About Testicular Torsion

Testicular torsion (also called testis torsion) happens when the spermatic cord that provides blood flow to the testicle rotates and becomes twisted, usually due to an injury or medical condition. This cuts off the testicle’s blood supply and causes sudden, severe pain and swelling.

Testicular torsion requires immediate surgery to fix. If it goes on too long, it can result in severe damage to the testicle and even its removal.

Torsion can happen to males of any age, including newborns and babies, but is most common in 10- to 25-year-olds and teens who’ve recently gone through puberty.

Causes

The scrotum is the sack of skin beneath the penis. Inside the scrotum are two testes, or testicles. Each testicle is connected to the rest of the body by a blood vessel called the spermatic cord.

Testicular torsion is when a spermatic cord becomes twisted, cutting off the flow of blood to the attached testicle.

Most cases of testicular torsion are in males who have a genetic condition called the bell clapper deformity. Normally, the testicles are attached to the scrotum, but in this condition the testicles aren’t attached, and therefore are more likely to turn and twist within the scrotum.

Testicular torsion also can happen after strenuous exercise, while someone is sleeping, or after an injury to the scrotum. Often, though, the exact cause isn’t known.

Symptoms

If your son has sudden groin pain, get him to a hospital emergency room as soon as you can. Testicular torsion is a surgical emergency — when it happens, immediate surgery is needed to save the testicle.

Because surgery may be necessary, it’s important to not give a boy with testicular pain anything to eat or drink before seeking medical care.

If your son has testicular torsion, he’ll feel a sudden, possibly severe pain in his scrotum and one of his testicles. The pain can get worse or ease a bit, but probably won’t go away completely.

Other symptoms:

• swelling, especially on one side of the scrotum
• nausea and vomiting
• abdominal pain
• one testicle appears to be higher than the other

Sometimes, the spermatic cord can become twisted and then untwist itself without treatment. This is called torsion and detorsion, and it can make testicular torsion more likely to happen again in the future.

If your son’s spermatic cord untwists and the pain goes away, it might be easy to dismiss the episode, but you should still call a doctor. Surgery can be done to secure the testicles and make testicular torsion unlikely to happen again.

Diagnosis

When you get to the hospital, a doctor will examine your son’s scrotum, testicles, abdomen, and groin and might test his reflexes by rubbing or pinching the inside of his thigh. This normally causes the testicle to contract, which probably won’t happen if he has a testicular torsion.

The doctor also might do tests to see if the spermatic cord is twisted, including:

• Ultrasound: High-frequency waves are used to make an image of the testicle and check blood flow.
• Urine tests or blood tests: These can help determine whether symptoms are being caused by an infection instead of a torsion.

Sometimes, a doctor will have to perform surgery to make a diagnosis of testicular torsion. Other times, when the physical exam clearly points to a torsion, the doctor will perform emergency surgery without any other testing in order to save the testicle.

Saving a testicle becomes more difficult the longer the spermatic cord stays twisted. The degree of twisting (whether it’s one entire revolution or several) determines how quickly the testicle will become damaged. As a general rule:

• within about 4-6 hours of the start of the torsion, the testicle can be saved 90% of the time
• after 12 hours, this drops to 50%
• after 24 hours, the testicle can be saved only 10% of the time

Treatment

Testicular torsion almost always needs surgery to fix. In rare cases, the doctor may be able to untwist the spermatic cord by physically manipulating the scrotum, but surgery usually is still needed to attach one or both testicles to the scrotum to prevent torsion from happening again.

Most torsion surgeries are done on an outpatient basis (with no overnight hospital stay). If your son has a torsion, he’ll be given a painkiller and a general anesthetic that will make him unconscious for the procedure.

Surgery consists of making a small cut in the scrotum, untwisting the spermatic cord, and stitching the testicles to the inside of the scrotum to prevent future torsions. Afterward, your son will be taken to a recovery room to rest for an hour or two before he’s released.

Following the surgery, your son will need to avoid strenuous activities for a few weeks, and if he’s sexually active, he’ll need to avoid all sexual activity. Talk to the doctor about when it will be safe for your son to return to his normal activities.

Testicle Removal

If a torsion goes on too long, doctors won’t be able to save the affected testicle and it will have to be removed surgically, a procedure known as an orchiectomy. Most boys who have a testicle removed but still have a viable testicle can father children later in life. However, many also opt for a prosthetic, or artificial, testicle a few months after surgery. This can help make some boys feel more comfortable about their appearance.

With newborn boys, saving the testicle depends on when the torsion happens. If it’s before a boy is born, it may be impossible to save the testicle. In this case, the doctor may recommend a surgery at a later date to remove the affected testicle. If torsion symptoms appear after a boy is born, the doctor may recommend emergency surgery to correct the testicle.

Don’t Ignore Symptoms

Boys need to know that genital pain is serious and shouldn’t be ignored. Ignoring pain for too long or simply hoping it goes away can result in severe damage to the testicle and even its removal.

Even if your son has pain in his scrotum that goes away, he still needs to tell you or a doctor and get checked out. A torsion that goes away makes him more likely to have another one in the future. Doctors can greatly reduce the risk of another torsion by performing a simple surgical procedure that secures the testicles to the scrotum.

If your son had a torsion that resulted in the loss of a testicle, it’s important to let him know that he can still lead a normal life, just like anyone else. The loss of one testicle won’t prevent a man from having normal sexual relations or fathering children.

We’ve all heard of acid reflux — when stomach acids move up into the esophagus and cause a burning sensation — but there can be other types of reflux in the body. When urine (pee) refluxes from the bladder to the kidneys, it’s called vesicoureteral reflux (VUR).

Vesicoureteral (ves-ih-koe-yoo-REE-ter-ul) reflux happens when urine abnormally flows backward from the bladder into the ureters, thin tubes that connect the kidneys to the bladder. If backed-up urine reaches the kidneys, it can lead to infection, scarring, and even long-term kidney damage if left untreated. Fortunately, most kids with VUR don’t have a severe case of it and outgrow it with no long-term complications.

Treatment depends on the severity of the condition. In mild cases, no treatment is necessary. Moderate to severe cases may be treated with antibiotic medicines to prevent infection. In cases where kids have infections and fevers along with the VUR, surgery may be needed.

How the Urinary Tract Works

The urinary tract is made up of two kidneys, two ureters, one bladder, and one urethra. Kidneys are fist-sized, bean-shaped organs in the back that filter excess fluids and waste products from the blood and turn them into urine. The urine then flows out of the kidneys through the ureters, which are long, thin tubes.

The ureters transfer urine to the bladder, a balloon-like organ that stores the urine until it’s emptied during urination. While it’s in the bladder, urine is prevented from flowing back into the ureters by valves in the bladder. During urination, it exits the body through the urethra, a tube at the bottom of the bladder.

Causes

Normally, urine flows from the kidneys to the bladder, but defects in one or both ureters can allow it to flow the other way. So can a blockage in the ureters or in the bladder.

When a defect causes the condition, it’s called primary VUR. This is the most common type of VUR affecting kids. If a child is born with primary VUR, it means that a ureter didn’t grow long enough while the baby was in the womb. This can affect the valve where the ureter enters the bladder. If the valve doesn’t shut properly, urine can flow back up the ureters to reach the kidney. Primary VUR is believed to be a genetic condition.

If a blockage in the urinary tract obstructs the flow of urine and causes it to go back into the kidneys, it’s called secondary VUR. Kids with this type of VUR often have reflux in both ureters. Secondary VUR can be caused by nerve damage, infection, or pressure on the ureter from another organ, such as an enlarged prostate.

Symptoms

Most of the time, VUR has no obvious signs or symptoms. It’s often first detected when a child has a urinary tract infection (UTI) with a fever.

Symptoms of a UTI include:

lower tract infection (in the bladder)

• frequent or urgent need to urinate
• a burning sensation while urinating
• blood in the urine, or urine that is cloudy or foul smelling

upper tract infection (in the ureters or kidneys)

• pain in the side or abdomen
• fever and chills

As kids get older, untreated VUR, along with any related UTIs, can lead to long-term problems caused by scarring of the kidney. These problems include:

• high blood pressure (hypertension)
• protein in the urine
• decreased kidney function or kidney failure

In some cases, VUR may be detected before a baby is born during a routine prenatal ultrasound. An ultrasound uses sound waves to create an image of the baby in the womb. Ultrasounds can sometimes show if a baby has swollen kidneys (hydronephrosis), which could be a sign of VUR.

Diagnosis

If your child has symptoms of a UTI, see a doctor right away. To check for VUR, the doctor will do a physical examination and ask you questions about your family medical history. Blood and urine tests may be done to see how well your child’s kidneys are functioning and check for signs of infection or damage to the kidneys.

Doctors can use certain tests to confirm a diagnosis of VUR, such as:

• An abdominal ultrasound, also called sonography, uses harmless sound waves to create images of the urinary tract and may reveal a defect or blockage that could potentially cause VUR.
• A voiding cystourethrogram (VCUG) is an X-ray image of the bladder and urethra taken while someone is urinating. In this procedure, a special liquid that can be seen on X-rays is placed in the bladder through a catheter (rubber tube). X-rays are taken of the bladder while it is full and while it is being emptied during urination, and then the images are compared to check for abnormalities.

If VUR is diagnosed, the doctor will grade the condition from I through V based on its severity, and use the grade to decide the best course of treatment. Grade I reflux is the mildest, with urine that backs up only as far as the ureters. Grade V reflux is the most severe and can involve twisting of the ureter and swelling of the kidney.

Treatment

In many cases, kids with primary VUR outgrow it. As a child gets older, the ureter gets longer and straighter, and the valve where the ureter enters the bladder is able to shut correctly.

VUR that occurs with a UTI needs prompt antibiotic treatment to keep the infection from spreading to the kidneys. Kids who are put on antibiotics should take them for as long as prescribed, even if they start to feel better early on.

In moderate to severe cases of primary VUR with UTIs and fever, the doctor may recommend surgery. The most common type of surgery is ureteral reimplantation, in which one or both ureters are extended further into the bladder to correct the backflow of urine from the bladder to the ureters and kidneys. This type of surgery usually requires kids to spend a few days in the hospital while they recover.

Another surgical procedure, endoscopic injection, involves injecting a special gel into the bladder with the use of a catheter. The gel, placed near the valve at the opening of the ureter, prevents urine from going back into the ureter and helps the valve close properly. Most kids can leave the hospital on the same day that they have this procedure.

To treat a case of secondary VUR, antibiotics are given to fight infections and surgery might be done to remove the blockage causing the reflux.

Moderate to severe VUR, if not treated, can lead to serious health problems down the road. But with prompt treatment, long-term complications and damage to the kidneys can be prevented.