Pediatric Kidney Issues: Bedwetting and Urinary Concerns

Q: Pediatric Kidney Issues: Bedwetting and Urinary Concerns

Hello： "Nephroptosis" (also called floating kidney or renal ptosis) refers to a condition where the kidneys, located on either side of the spine in the abdominal cavity, become mobile. <br>Normally, the kidneys are surrounded by a layer of fat that not only protects them but also

Pediatric kidneys

Hello Dr.
Fei: My ten-year-old child was very underweight at birth and has a condition of ectopic kidney.
He still experiences bedwetting, drinks a lot of water during the day, has a high frequency of urination, and his urine has a significant amount of bubbles that do not dissipate quickly, with a strong odor.
I am unsure of the reasons for these symptoms.
What tests and treatments are necessary? I would appreciate your help in clarifying this! Thank you!

Worried Mom, 40~49 year old female. Ask Date: 2011/06/27

Dr. Pei Rensheng reply Pediatrics

Hello: "Nephroptosis" (also called floating kidney or renal ptosis) refers to a condition where the kidneys, located on either side of the spine in the abdominal cavity, become mobile.
Normally, the kidneys are surrounded by a layer of fat that not only protects them but also helps to anchor them in place.
However, in some individuals, the kidneys are not fixed and can move around, changing positions with changes in posture, which is referred to as "nephroptosis." This condition is commonly seen in slender young women or middle-aged women.
The right kidney is more likely to experience nephroptosis than the left, and in 15% of cases, both kidneys may be affected.

The underlying cause is the relaxation of the surrounding fascia, which allows the kidneys to become mobile.
The kidneys may shift positions with changes in posture; when lying down, they may drop below the diaphragm, but when sitting or standing, gravity can cause them to descend to the level of the fourth or fifth lumbar vertebra, and in some cases, they may even descend to the upper margin of the bladder.

Most individuals with nephroptosis do not experience significant symptoms, although a minority may report lower back discomfort, pain (which alleviates when lying down), hematuria, or proteinuria, and in some cases, a palpable floating kidney may be detected in the abdomen or lower back.
The exact cause of nephroptosis remains unclear in the medical community.

It is important to note that some patients with nephroptosis may develop renal hypertension, hydronephrosis, or ureteral dilation.
This is primarily due to the twisting or bending of the renal artery and ureter as the kidney moves.
Therefore, patients with nephroptosis should have regular blood pressure monitoring, kidney function tests, and routine urinalysis.
Most patients do not require surgical intervention; lifestyle changes, such as gaining weight, may be sufficient.
However, if excessive movement of the kidney leads to renal hypertension, hydronephrosis, or ureteral dilation, surgical treatment may be considered.

Previously, surgery required an open approach to suture the kidney to the retroperitoneal fascia, but with advancements in laparoscopic techniques, the upper or lower pole of the kidney can now be fixed using laparoscopic surgery, suturing the kidney to the retroperitoneal fascia, with a success rate of over 90%.

Wishing you health and happiness!
Dr.
Pei Ren-Sheng, Director of Pediatrics, Taoyuan Hospital, Department of Health.

Reply Date: 2011/06/27

More Info

Understanding pediatric kidney issues, particularly in the context of bedwetting, frequent urination, and the presence of foamy urine, requires a comprehensive approach that considers both physiological and psychological factors. In the case of your ten-year-old child, several symptoms are present: a history of nephroptosis (floating kidney), bedwetting, high frequency of urination, foamy urine, and a strong odor. Each of these symptoms can provide clues to underlying kidney function and health.

Nephroptosis and Its Implications
Nephroptosis, or floating kidney, is a condition where the kidney is not fixed in its normal position and can move within the abdominal cavity. This condition is more common in slender individuals and can lead to complications such as renal hypertension or hydronephrosis if the kidney's blood supply or urinary drainage is compromised. While many individuals with nephroptosis are asymptomatic, some may experience symptoms like flank pain, hematuria (blood in urine), or proteinuria (excess protein in urine).
In your child's case, the presence of foamy urine could indicate proteinuria, which may suggest that the kidneys are not filtering properly. This can be a sign of kidney damage or disease, and the strong odor may indicate concentrated urine, possibly due to dehydration or an underlying infection.

Diagnostic Approach
Given these symptoms, a thorough evaluation is warranted. Here are some recommended steps:
1. Urinalysis: A comprehensive urinalysis can help identify the presence of protein, blood, or signs of infection. It can also provide information about the concentration of urine.

2. Blood Tests: Tests to assess kidney function, such as serum creatinine and blood urea nitrogen (BUN), can help determine how well the kidneys are functioning.

3. Imaging Studies: An ultrasound of the kidneys can help visualize the structure and position of the kidneys, checking for any abnormalities such as hydronephrosis or structural defects.

4. 24-Hour Urine Collection: This test can provide detailed information about kidney function, including the amount of protein being excreted.

5. Referral to a Pediatric Nephrologist: If initial tests indicate potential kidney issues, a referral to a specialist may be necessary for further evaluation and management.

Treatment Options
The treatment will depend on the underlying cause of the symptoms. If nephroptosis is contributing to the symptoms, management may include:
- Weight Management: In some cases, gaining weight can help stabilize the kidney's position.

- Monitoring: Regular follow-ups to monitor kidney function and any changes in symptoms.

- Medication: If there is evidence of hypertension or significant proteinuria, medications may be prescribed to manage these conditions.

For bedwetting, behavioral interventions, such as bladder training and moisture alarms, may be effective. In some cases, medications like desmopressin can help reduce nighttime urination.

Conclusion
In summary, your child's symptoms warrant a thorough evaluation to rule out any serious kidney issues, especially given the history of nephroptosis. Regular monitoring and appropriate interventions can help manage the symptoms effectively. It is essential to work closely with healthcare providers to ensure that your child receives the best possible care tailored to their specific needs.

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