In this issue of Pediatric Annals, we present five of the most encountered nephrology conditions in general pediatric practice. Hypertension, which is becoming increasingly diagnosed in children and tied to the obesity epidemic, is currently faced by pediatricians almost daily.
Although the incidence of primary hypertension in children has increased, an important task of the pediatric practitioner is to rule out causes of secondary hypertension, some of which may lead to devastating consequences if left untreated. In the article, “Hypertension in Children and Adolescents: A Review of Recent Guidelines,” Drs. Sahar Siddiqui and Rossana Malatesta-Muncher summarize the importance of accurate diagnosis, appropriate evaluation, and initial management of high blood pressures in children. The article also highlights, for the pediatric primary care provider, the most recent American Academy of Pediatrics (AAP) clinical practice guidelines for hypertension in children.
The importance of evaluation, referral, and treatment of hypertension in children is further highlighted in the article, “Pediatric Hypertension and End-Stage Renal Disease,” by Drs. Karyn Gerstle, Shireen Hashmat, Christopher Clardy, and Joseph R. Hageman. This article, which presents an illustrative case of a child who was found to have end-stage renal disease after being evaluated for stage 2 hypertension, stresses the importance of prompt attention to elevated blood pressure in children.
Another renal condition on the rise in children, also associated with poor dietary habits, is nephrolithiasis. The increasing prevalence of renal stones may be partially explained by improved diagnostic methods, but more importantly so by the change in dietary patterns of the last few decades. The article, “Pediatric Nephrolithiasis: Risk Factors, Evaluation, and Prevention,” by Dr. Sermin A. Saadeh discusses the linkage of current dietary practices to metabolic and genetic risk factors for the formation of renal stones in children and adolescents. This article will guide the pediatric provider to the initial management of these patients as well as provide the basis for the role of dietary counseling.
Although a urinalysis is no longer recommended by the AAP as part of the well-child examination, many pediatricians continue to check the results of a urinary dipstick every year. As renal disease is often asymptomatic or may present with very subtle or nonspecific signs and symptoms, the urine dipstick can be a valuable tool in the diagnosis of kidney disease, especially because it is inexpensive and easy to do in the pediatric office setting. Often, the urinary dipstick in an asymptomatic healthy child shows blood and/or protein, or blood/protein is found in the urine as part of the evaluation of a specific symptom such as abdominal pain. Some of these patients will require an extensive evaluation and referral to a pediatric nephrologist, whereas others can only be monitored without further investigations. The article, “Proteinuria in Children,” by Dr. Daniel Ranch guides the clinician in the approach to the evaluation and management of these patients.
When blood and protein are present in the urine at the same time it may indicate acute glomerulonephritis. Postinfectious glomerulonephritis continues to be the most common cause of glomerulonephritis in children, and although in the past it was mainly associated with streptococcal infection, we now know that it may occur secondary to infections with many other infectious agents. The article, “Postinfectious Glomerulonephritis,” by Drs. Dunya Mohammad and Rossana Baracco reviews this condition, including an illustration to aid in the differential diagnosis of acute glomerulonephritis in children.