Nephrology focuses on diagnosing and treating kidney diseases. The kidneys filter waste, balance fluids, regulate blood pressure, and manage acute and chronic conditions.
Send us all your questions or requests, and our expert team will assist you.
Diagnosing the need for dialysis in a child is a careful, multi-step process. The decision is usually made over multiple appointments. Doctors must gather evidence from blood work, urine samples, and detailed pictures of the inside of the body to understand exactly how much kidney function remains. The evaluation is a journey that moves from identifying the problem to planning the solution.
The goal of the evaluation is not just to name the disease but to determine the “tipping point”—the moment when the risks of untreated kidney failure outweigh the burden of starting dialysis. This involves checking not just the kidneys but also the child’s heart, bones, and nutritional status. It requires a partnership between the laboratory and the bedside to build a complete picture of the child’s health.
The most important tool for measuring kidney health is a blood test. Doctors look for specific waste products that healthy kidneys usually remove.
The two main markers are creatinine and blood urea nitrogen (BUN). Creatinine comes from muscle wear and tear. As kidneys fail, creatinine levels in the blood rise. Doctors use this number, along with the child’s height, to calculate the Glomerular Filtration Rate (GFR). This indicator tells them the percentage of kidney function remaining. They also monitor electrolytes like potassium, which can stop the heart if levels get too high, and bicarbonate, which indicates if the blood is becoming too acidic.
Urine provides a window into the kidney’s filtering ability. By analyzing a sample, doctors can see what the kidneys are losing that they should be keeping.
They look for protein (albumin) and blood cells. High levels of protein in the urine suggest the filters are leaky. They also look at the concentration of the urine. If the urine is very watery despite the child not drinking much, it means the kidneys have lost the ability to concentrate waste. Collecting urine over 24 hours provides the most accurate measurement of how much protein is being lost and how much waste is being cleared.
To understand the cause of the failure, doctors need to see the kidneys. Imaging studies are non-invasive ways to look at the anatomy.
This is usually the first test. It uses sound waves to create a picture of the kidneys and bladder. It is painless and safe. It can show if the kidneys are too small, if they have cysts, or if there is a blockage causing urine to back up (hydronephrosis).
This test is more invasive but necessary for diagnosing reflux or blockages. A catheter is placed in the bladder, and dye is injected. X-rays are taken while the child urinates. It shows if urine is going backward up the ureters towards the kidneys, a common cause of damage in children.
Sometimes, blood and urine tests don’t give the specific cause. In these cases, a kidney biopsy may be needed.
A biopsy involves taking a tiny sample of kidney tissue using a needle. This is done under sedation or anesthesia so the child does not feel pain or move. The tissue is examined under a microscope to look for specific diseases like glomerulonephritis or scarring. This helps doctors decide if the kidney failure can be reversed with medication or if dialysis is the only option.
Because growth is such a critical part of pediatric health, the evaluation includes a thorough nutritional assessment.
A dietitian will analyze the child’s eating habits. They measure height and weight carefully to track growth velocity. They check blood levels of iron, vitamins, and parathyroid hormone (PTH). High PTH indicates that bone health is at risk. This information helps the team decide if the child needs a feeding tube or growth hormone therapy before or during dialysis.
Deciding when to start dialysis is a clinical judgment. It is not based on a single number but on the child’s overall condition.
Doctors look for symptoms that cannot be managed with medicine and diet alone. Uncontrollable fluid overload causing breathing trouble, dangerously high potassium levels, severe growth failure, or extreme fatigue are all triggers. The team discusses the timing with the family, aiming to start dialysis in a planned, calm manner rather than in an emergency crisis. This allows time for surgery to place a catheter and for the family to receive training.
Send us all your questions or requests, and our expert team will assist you.
It involves a needle stick, which hurts for a moment. Pediatric phlebotomists are skilled at making this quick and using distraction techniques to help the child.
The VCUG requires filling the bladder to see if urine backs up when the child pees. The tube is the only way to get the dye into the bladder.
For ultrasounds and blood tests, this is not necessary. For a biopsy or occasionally a VCUG in very anxious children, sedation is used to keep them calm and still.
GFR stands for Glomerular Filtration Rate. It is a score that tells you how well the kidneys are cleaning the blood. A lower number means less function.
Waiting too long can be dangerous. It can lead to heart failure or permanent developmental delays. The team will guide you to the safest start time.
Your Comparison List (you must select at least 2 packages)
