International Conference on
Pediatrics and Pediatric Nephrology

In the prenatal period, Congenital abnormalities of the kidneys & urinary tract are the most common Sonographically identified malformations. In the fetus, child, or adult, a pager proportion of kidney cysts are due to genetic diseases when compared with adults. The ultimate aim of prenatal diagnosis is to detect the renal anomalies which are having impact on the prognosis of the affected child & requiring early postnatal evaluation or treatment to minimize adverse outcomes.

In recent study, it is found that, Glomerular diseases are the cause for Renal Failure in 30% - 50% of patients undergoing transplantation. Disorder of Glomerular Structure and Function are found more frequently in clinical medicine. The application of renal biopsy techniques can provide useful information for both prognosis and treatment.

These disorders can evoke a variety of clinical syndromes, including acute glomerulonephritis, rapidly progressive glomerulo-nephritis, nephrotic syndrome, "symptomless" hematuria and/or proteinuria, and chronic glomerulonephritis. Glomerular Diseases are the leading cause of Chronic Kidney Diseases. There are less information available regarding the treatment of CKD caused by Glomerular Diseases. Most of the glomerulopathy can progress to Chronic Kidney Diseases if not treated early when the disease is most active.

Acute kidney injury is the abrupt loss of kidney function that results in a decline in glomerular filtration rate (GFR), retention of urea and other nitrogenous waste products, and dysregulation of extracellular volume and electrolytes. The incidence of Acute Kidney Injury in Children appears to be increasing. Genetic Factors may predispose some children to AKI. Children who have suffered Acute Kidney Injury are at risk for late development of kidney disease several years after the initial insult. Improved understanding of the pathophysiology of AKI, early biomarkers of AKI, and better classification of AKI are needed for the development of successful therapeutic strategies for the treatment of AKI.

The major anomalies of the genitourinary tract are now reconstructed in infancy and from the pediatric point of view the results are good. However, they leave a legacy of potential morbidity in adolescence and adult life. Many problems are predominantly medical or psychosocial rather than surgical in nature and it is essential to adopt a holistic approach to long-term care. Close collaboration between pediatric and adolescent or adult urologists is also important to ensure continuity of follow-up and specialist care.

Pediatric End-Stage Renal Diseases affects children of all ages. The outcome of End-Stage Renal Diseases in Children has considerably improved since the development of dialysis and kidney transplantation. Children constitute 1-2% of total ESRD population, but the devastating effects of ESRD are more significant than in adults. The mortality rate of children on dialysis is estimated to be 30 to 150 times higher than genal pediatric population. When examined by age, peritoneal dialysis is the most common initial ESRD treatment modality for children age 9 years and younger. Hemodialysis is the least common initiating modality in small children and increases in frequency with increasing patient weight.

For more than a decade, Cardiovascular Disease(CVD) was recognized as a major reason of the death in Children with advanced Chronic Kidney Diseases. Similar to adults, Children have extremely high prevalence of traditional and uremia-related CVD risk factors. As a population without preexisting symptomatic cardiac disease, children with CKD potentially receive significant benefit from aggressive attempts to prevent and treat CVD. Early CKD, before needing dialysis, is the optimal time to both identify modifiable risk factors and intervene in an effort to avert future CVD. Slowing the progression of CKD, avoiding long-term dialysis and, if possible, conducting preemptive transplantation may represent the best strategies to decrease the risk of premature cardiac disease and death in children with CKD.

Congenital Renal Diseases are the renal conditions with which a child is born. These conditions are passed down through genetics or development in the womb. Autosomal dominant polycystic kidney disease (ADPKD) and Autosomal recessive polycystic kidney disease (ARPKD) are genetic kidney diseases in Children. There are no cures for Congenital Renal Diseases. These conditions require lifelong careful monitoring and treatment.

In adults where hypertension is a leading cause of chronic kidney disease, however, in pediatrics, hypertension is the condition from prior disease or injury. There is a significant issue with the unrecognized hypertension in childhood chronic disease. Although Chronic Kidney Disease is relatively rare in children as compared with adults, hypertension is highly prevalent. The prevalence of Hypertension is tenfold higher than in general pediatrics and know to increase as children progress through the stages of CKD. Now, there are many studies demonstrating an interaction between Chronic Kidney Disease and Hypertension, with hypertension likely hastening the progression of CKD towards End Stage Renal Disease.

Penile and Urethral Cancers are rare. Because of their rarity, delay in diagnosis secondary to both patient and physician factors are a constant threat. Any lesion of the penis that cannot be definitively diagnosed must be considered cancer until otherwise proven. Glans penis masses are extremely rare in childhood. Fibroepithelial polyps of glans penis are very rarely seen in childhood. The search for the optimal management of penile and urethral cancer continues. Controversy revolves around organ-sparing vs non–organ-sparing techniques and minimally invasive vs standard techniques. Fortunately, these diseases are infrequent, but this very infrequency is impeding more rapid evolution of a consensus opinion.

Bladder exstrophy, a rare birth defect where the bladder is not contained inside the abdomen, but is visible on the outside of the body. This condition is more common among boys than it is among girls. Children with bladder exstrophy often have other abnormalities, such as an unusually wide pelvic bone structure or problems with abdominal muscles. Girls with bladder exstrophy may have a urinary opening in the wrong place, or one that’s very large or misshapen. Girls with bladder exstrophy also may have a split clitoris. Boys with bladder exstrophy may have a deformed penis, or it may be curved downward. Boys with bladder exstrophy also may have an unusually short urethra, or one that’s on the upper part of the penis, instead of on the tip.

Urinary bladder masses are rare in children and the histologic features & prognoses are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. The frequencies and types of bladder diseases differ between adults and children, although there is some overlap. The most common bladder malignancy in children is a rhabdomyosarcoma, whereas the most common benign bladder lesion in the pediatric population is a papillary urothelial neoplasm of low malignant potential (PUNLMP).

When there is a suspect of kidney diseases, a physical examination and urine tests, blood tests, imaging, or biopsy will help to make a diagnosis. These are usually suggested by the doctors in Pediatric Urology and Pediatric Nephrology study. The main causes for the kidney damage in children will be hereditary, in some cases due to the unhealthy lifestyle. Some kidney problems can be found before birth by ultrasound. Sometimes, children are diagnosed with other conditions where kidney problems are known to be more common. Usually, there are other concerns about a child's health that can possibly lead to a diagnosis of CKD.

When kidney disease hits the child/infant, the dialysis will be the temporary live saving procedure. There have been many advancements and researches done in the dialysis technology which lowered the risk of patient’s death. In a recent news, it is found that the available dialysis machines will not be suitable for the children with the kidney diseases. The most recent news regarding the dialysis is the Bioengineered cells can be used for dialysis. Peritoneal Dialysis is most commonly the initial modality in small children. Hemodialysis is the least common initiating modality in small children and increases in frequency with increasing patient weight

Vesicoureteral reflux(VUR), an abnormal movement of urine from the bladder into ureters or kidneys. It may present before birth as prenatal ureterohydronephrosis, an abnormal widening of the ureter, or with a urinary tract infection or acute pyelonephritis. Vesicoureteral reflux is estimated to occur in 1% to 3% of children. Younger children are more prone to Vesicoureteral reflux because of the relative shortness of the submucosal ureters. In children with Urinary Tract Infections, the incidence of VUR is 29% in boys and 14% in girls. Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most children with the cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate.

Under possible conditions, surgery is the main treatment for kidney cancers that can be removed. Kidney tumor ablation is an effective alternative to surgical resection for small renal tumors that have not spread beyond the kidney. It is a minimally invasive, nonsurgical procedure with a recovery time of less than 24 hours. Radio Frequency Ablation of tumors in children has been performed in only a small number of cases.

Pediatric urology procedures are necessary for treating children’s urological conditions. These disorders or conditions are typically congenital, meaning they are present at birth. Surgery is the primary treatment for most types of urological conditions. Specifically, robotic laparoscopic surgery has become the standard of care. Surgeons rely on this minimally invasive approach because it’s generally less painful, requires a shorter hospital stay, and has a shorter recovery time than traditional open surgery. Circumcision, an elective urological procedure to remove the foreskin from the penis, is normally performed in the first few days after a baby is born.

Transplantation in children is one of the best options to treat renal failure. Nearly half of children who have received transplants have a functioning kidney graft 14 years after transplantation. Preemptive transplantation is optimal treatment of pediatric ESRD for maintaining growth and development of children. Unfortunately, the other half have returned to dialysis and require a second transplant during childhood or adolescence. In some cases, the transplanted kidney can be rejected due by the recipient’s immune system. In a recent research, it is explained that over the last 25 years the improvements in therapy have reduced the risk of early acute rejection and graft loss, but the long term results in terms of graft survival and morbidity require search for new immunosuppressive regimens. Tolerance of the graft and reducing the side effects are the challenges for improving the outcome of children with a grafted kidney.

Children with Kidney Diseases may have a negative self-image and may have relationship problems with family members or friends due to the stress of living with a chronic disease. The condition can lead to behaviour problems and difficulty participating in school and extracurricular activities. Parents and other adults should help children with kidney diseases to fit in at school, deal with low self-esteem, make friends, be physically active, and follow their treatment regimen. As children approach adulthood, they may need help with preparing to enter the workforce.

As a consequence, we are exposed to and have to accommodate advances in many different areas of medicine from endocrine treatment of the fetus to exploring the limits of robotic surgery. At the basic level of our surgical lives is surgical technique which has undergone steady refinement over centuries and decades with the occasional boost given by a conceptual breakthrough. The steady improvement in results from advances in suture material was a passive benefit but the conceptual advance of enlarging the bladder using bowel was ahead of its time and doomed to failure until the game-changing process of intermittent catheterization came to its rescue. The world of transplantation has grown enormously since the first renal transplant more than half a century ago. Unfortunately, the expansion of our speciality in terms of centers as well as individuals has coincided with a downward trend in the numbers of patients with serious congenital anomalies. One of the simple factors is simply the declining birth rate.