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Part1: Basic Information about Kidney
Part 2: Major Kidney Diseases and their Treatment
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FAQ
- What are the kidneys?
Normally, there are two kidneys, located at upper and back side of the abdomen, one on either side of the spine under the lower ribs.They are a pair of bean shaped organs and in adults; each kidney is about the size of a closed fist. Additional information on chapter 2, page 3
- Why do we need our kidneys?
Our kidneys purify the blood, regulate fluids, minerals and blood pressure, assist in the production of red blood cells and keep our bones healthy. Additional information on chapter 2, page 5
- What are the symptoms of kidney diseases?
The symptoms of kidney diseases are variable and depend on the type of underlying disease and its severity. The common symptoms include the swelling of face (most noticeable in the morning), loss of appetite, nausea, vomiting, hypertension at young age, weakness, pallor, reduced urine volume, burning sensation in urine, difficulty in ‘voiding’ and the presence of blood in urine. Additional information on chapter 3, page 9
- When to suspect kidney diseases in a person suffering from high blood pressure?
Kidney diseases can be suspected in a patient if hypertension is diagnosed at a young age (less than 30), blood pressure is very high at the time of diagnosis, blood pressure can not be controlled with regular treatment or other symptoms of kidney diseases are noticeable such as swelling, loss of appetite and weakness. Additional information on chapter 11, page 46
- Who is at high risk for developing kidney diseases?
Anyone can develop chronic kidney disease. However people suffering from high blood pressure or diabetes or long term treatment with pain relievers are at a higher risk of developing kidney diseases. A family history of kidney diseases or congenital defects of uninary tracts also leads to greater risk of developing kidney diseases. Additional information on chapter 4, page 11
- Which tests are normally recommended to diagnose kidney problems?
The doctor advises appropriate tests considering the illness of the patient. Routinely performed and most important screening tests for kidney disease are urine test, serum creatinine and ultrasound of kidney. Additional information on chapter 4, page 11
- What is ‘kidney failure’?
Kidney failure refers to the reduction in the ability of the kidney to filter and excrete waste products. Additional information on chapter 8, page 35
- Which tests are performed to diagnose kidney failure?
- When is kidney biopsy advised?
In certain kidney diseases detailed medical history, examination and tests are unable to establish proper diagnosis. In such patients a kidney biopsy may be the only test which can clinch the exact diagnosis. Additional information on chapter 4 page 16
- How is the kidney biopsy performed?
The most common method is percutaneous needle biopsy, in which a hollow needle is passed through the skin into the kidney. Additional information on chapter 4 page 16
FAQ - Kidney Failure
- In person suffering from kidney failure, does one kidney fail or both?
Kidney failure occurs only when both kidneys fail. Usually people do not have any problem if one kidney fails completely, and in such cases, value of blood urea and serum creatinine in blood tests are normal.
But when both kidneys fail, waste products accumulate in the body, leading to a rise in blood urea and serum creatinine values. These raised values in the blood test suggest kidney failure. Additional information on chapter 6 page 24
- If one out of two kidneys fails, does it lead to kidney failure?
No. Failure or removal of one out of the two kidneys does not affect the overall kidney function because the other healthy kidney takes over the work load of both the kidneys. Additional information on chapter 8 page 35
- What is the difference between acute kidney failure and chronic kidney failure?
In acute kidney failure, the kidney function is reduced or lost within a short period (over hours, days or weeks) due to various reasons. This type of kidney failure is temporary, and usually reversible.
While gradual progressive and irreversible loss of kidney functions over several months to years is called chronic kidney disease or chronic kidney failure. This is a non- curable disease where kidney function reduces slowly and continuously and after a long period it may reduce to a stage where the kidney stops working almost completely. This advanced and life threatening stage of disease is called end stage kidney disease. Additional information on chapter 8 page 35
FAQ - Chronic Kidney Disease
- What is chronic kidney disease?
Gradual and permanent loss of kidney function is called chronic kidney disease (CKD). Raised value of serum creatinine in blood tests, and small and contracted kidneys on sonography are the hallmarks of chronic kidney disease. Additional information on chapter 10 page 42
- What are the causes of chronic kidney disease?
The two most important causes of chronic kidney disease are diabetes and high blood pressure. Other important causes are glomerulonephritis, polycystic kidney disease, ageing of the kidneys, renal artery stenosis, blockages to the flow of urine, drug-induced kidney damage, recurrent kidney infection in children and reflux nephropathy. Additional information on chapter 10 page 43
- What are the symptoms of chronic kidney disease?
Symptoms of chronic kidney disease vary as per the severity of the disease. During the early phase, there may be no warning symptoms. But early clues may be nocturia, elevated blood pressure, urine abnormalities and normal or slightly higher serum creatinine. Common early symptoms of kidney diseases are swelling, loss of appetite, nausea, weakness, severe or uncontrolled hypertension and pallor.
Advanced stage or end stage kidney failure patients are usually symptomatic. Some patients may not have symptoms and the problem may go undetected until the kidneys are severely damaged. Common problems at this advanced stage are severe nausea, vomiting, weakness, breathlessness, pallor, confusion, altered sensorium and convulsion. Additional information on chapter 11 page 44
- How to diagnose chronic kidney disease?
Three simple screening tests for the CKD are blood pressure measurement, urine test for albumin and serum creatinine blood test. Low hemoglobin, presence of protein in urine, raised value of creatinine and eGFR in blood test and small and contracted kidneys, seen on ultrasound, are the major diagnostic clues of chronic kidney disease. Additional information on chapter 11 page 48
- Which measures can help you treat chronic kidney disease medically and preserve kidney function?
Important measures in conservative treatment of chronic kidney disease are:
Meticulous treatment of underlying primary conditions such as diabetes mellitus, hypertension, urinary tract infection or obstruction, glomerulonephritis etc.
Strict blood pressure control (BP 130/80 mm of Hg).
Early use of ACE inhibitor or angiotensin II receptor–blocker therapy to control BP and reduce proteinuria.
Protein restriction to preserve kidney function.
Supportive treatment of symptoms of kidney failure (i.e. use of diuretics to increase volume of urine and reduce swelling, treatment of nausea and vomiting etc).
Lipid lowering therapy and correction of anemia.
Avoid painkillers (such as non-steroidal anti-inflammatory drugs), avoid certain natural medicines contain heavy metals and toxic substances which can cause damage to the kidney, give up smoking and tobacco products and limit alcohol intake to protect kidneys. Additional information on chapter 12 page 53
- Can we cure chronic kidney disease with medical management?
Chronic kidney disease is a progressively deteriorating condition with no cure. The aims of medical management and dietary restrictions are to protect kidney and slow down the progression of the disease, relieve symptoms, treat complications of the disease, reduce the risk of developing cardiovascular disease and delay the need for dialysis or transplant. Additional information on chapter 12 page 52
- Which is the most important treatment to prevent or delay the progression of CKD?
Whatever may be the underlying cause of CKD, strict control of blood pressure is the most important treatment to prevent or delay the progression of CKD. Uncontrolled blood pressure leads to rapid worsening of CKD and complications such as heart attack and stroke. Additional information on chapter 12 page 56
- How is anemia in CKD treated?
Supplementing iron and vitamins is the first step to treat anemia due to CKD. Severe anemia, or anemia not responding to drug therapy, needs injections of synthetic erythropoietin. Erythropoietin injection is safe, effective and the most preferred method of treating anemia due to CKD. Additional information on chapter 12 page 58
- When should a patient with CKD contact the doctor?
A patient with CKD should contact the doctor immediately if existing symptoms worsens, previously controlled high blood pressure becomes uncontrolled or newer symptoms such as fever develop. Additional information on chapter 11 page 50
FAQ - Diet in Chronic Kidney Disease
- What dietary restrictions are advised to patient with CKD?
To reduce the burden on the kidney with impaired function and to avoid disturbances in fluid and electrolytes balance, patients with chronic kidney disease should modify their diet as per the guidance of the doctor and the dietician. Dietary advices usually given are:
Salt restriction in patients with high blood pressure and swelling.
Limiting the intake of fluid and water in case of swelling.
Restriction of potassium and phosphorous.
Restriction of protein intake to 0.8 gm/kg of body weight/day. Supply adequate amount of carbohydrate, vitamins and trace elements. Additional information on chapter 25 page 195
- Why must patients of CKD take precautions in fluid intake?
As the kidney functions worsen in patients with CKD, the volume of urine usually decreases. Reduced urine output leads to water retention, causing puffiness of the face, swelling of the legs and high blood pressure. Accumulation of fluid in the lungs causes shortness of breath. Inadequately treated, severe breathlessness can be fatal. To avoid these problems, fluid restriction is advised in patients of CKD with swelling. Additional information on chapter 25 page 197
- Which foods are rich in salt (sodium)?
Example of foods rich in salt (sodium) are papad, pickles, potato chips, salted nuts etc. Additional information on chapter 25 page 202
- Which foods are rich in potasium?
Example of foods rich in potasium are fruit, fruit juices, coconut water, dry fruits etc. Additional information on chapter 25 page 205
- Why are CKD patients advised to restrict potassium in diet?
Removal of excess potassium in the urine may be inadequate in patients with chronic kidney disease, which can lead to high level of potassium in the blood (hyperkalemia). High potassium levels can cause severe muscle weakness or an irregular heart rhythm which can be dangerous. When potassium is very high, the heart can stop beating unexpectedly and cause sudden death. To avoid serious consequences of high potassium, CKD patients are advised to restrict potassium in diet. Additional information on chapter 25 page 204
FAQ - Dialysis
- What is dialysis?
When kidneys no longer function, dialysis is an artificial process by which waste products and unwanted water is removed from the body. It is a life saving kidney replacement therapy for patients with severe kidney failure. There are two main types of dialysis - hemodialysis and peritoneal dialysis. Additional information on chapter 13 page 59
- When is dialysis needed in CKD?
When kidney function reduces by 85 to 90 % (end stage kidney disease -ESKD), kidneys no longer remove enough wastes and fluid from the body and that leads to symptoms such as nausea, vomiting, fatigue, swelling and breathlessness. At this stage of CKD response to medical management is inadequate and the patient needs dialysis. A patient with CKD usually needs dialysis when blood test shows 8.0 mg/dl or more serum creatinine. Additional information on chapter 13 page 59
- Will dialysis performed once in patients with renal failure, subsequently become a permanent need?
The period for which a patient with kidney failure needs dialysis depends on the type of kidney failure. In acute kidney failure, it is only needed for a short duration (days to weeks). Acute kidney failure is a temporary and reversible type of kidney failure.
Chronic kidney disease is a progressive and irreversible type of kidney failure. Advanced stage of chronic kidney disease (End Stage Kidney Disease) needs regular lifelong dialysis support. Additional information on chapter 9 page 41
- How is hemodialysis done?
In hemodialysis, the blood is purified and excess fluid removed with the help of a dialysis machine and a dialyzer (artificial kidney). Additional information on chapter 13 page 61
- What is AV fistula used for hemodialysis?
The arteriovenous or AV fistula is the most common and the best method of vascular access for long term hemodialysis. Additional information on chapter 13 page 63
- What is CAPD?
Continuous Ambulatory Peritoneal Dialysis (CAPD) is a widely accepted and effective modality for the patients with end stage kidney disease. CAPD can be carried out by a person at home without the use of a machine. As CAPD provides convenience and independence it’s a popular dialysis modality in developed countries. Additional information on chapter 13 page 74
- How is CAPD done?
Continuous Ambulatory Peritoneal Dialysis (CAPD) is done at home, usually without a machine. In CAPD a soft tube called a catheter is inserted in the abdomen. Through the catheter, dialysis solution is infused into the abdominal cavity. Dialysis fluid (dialysate) remains in the peritoneal cavity for hours (dwell time), during which process of purification occurs. Subsequently, PD fluid with waste products and excess fluid is drained out through the catheter. Additional information on chapter 13 page 74
FAQ - Kidney Transplantation
- When is kidney transplant necessary?
Kidney transplant is necessary in a patient with chronic kidney diseases when the kidney function reduces by 85-90% of its original capacity (end stage kidney disease). Additional information on chapter 14 page 80
- Who can donate a kidney?
Healthy persons with two kidneys can donate a kidney if the blood group and tissue types are compatible with the recipient. Generally, donors should be between the ages of 18 and 65 years. A kidney donated by a parent or sibling of the recipeint results in the most successful kidney transplantation. When living kidney donor is not available, the only option is a deceased or cadaver donor. Additional information on chapter 14 page 83
- What are the advantages of kidney transplantation?
Major advantages of successful kidney transplantation are better quality of life, longevity, freedom from dialysis and fewer dietary restrictions. Additional information on chapter 14 page 81
- Does the recipient need any medication or precautions after kidney transplant?
Yes. After a kidney transplant, the recipient needs regular medication (e.g. immunosuppressant drugs, antihypertensive drugs, vitamins etc) and precautions to keep the transplanted kidney healthy. Precautions to prevent infections, regular consultation with the nephrologist and periodic laboratory tests are also necessary. Additional information on chapter 14 page 88
FAQ - Deceased Kidney Transplantation
- What is deceased (cadaver) kidney transplantation?
The operation by which a healthy kidney donated by a person with brain death or cardiac death is transplanted in a patient with chronic kidney disease is known as deceased or cadaver transplantation. Additional information on chapter 14 page 93
- What is “Brain Death”?
“Brain Death” is a complete cessation (stopping) of all brain functions which do not recover with any medical or surgical treatment. “Brain Death” is a diagnosis in hospitalized unconscious patients on ventilator support. In a patient with “Brain Death”, respiration and the beating of the heart will stop as soon as the ventilator is switched off. Additional information on chapter 14 page 94
FAQ - Diabetic Kidney Disease
- Why is it important to know about diabetic kidney disease?
Diabetic kidney disease (diabetic nephropathy) is the leading cause of chronic kidney disease. It is responsible for 40-45 % of newly diagnosed patients of end stage kidney disease (ESKD). Early diagnosis and treatment can prevent diabetic kidney disease. In diabetes with established chronic kidney disease, meticulous therapy can postpone the stage of dialysis and transplantation significantly. So awareness, prevention, early diagnosis and meticulous treatment of diabetic kidney disease are extremely essential. Additional information on chapter 15 page 99
- How many diabetics develop diabetic kidney disease?
Incidence of diabetic kidney disease is very high - about 30 - 35% in patients with Type 1 diabetes mellitus, while it’s about 10 - 40% in Type 2 diabetics. Additional information on chapter 15 page 100
- What are the common symptoms of diabetic kidney diseases?
Common symptoms of diabetic kidney disease are the presence of protein in the urine, development of high blood pressure, swelling of the ankles, feet and face, decreased requirement of insulin or antidiabetic medications and frequent hypoglycemia (low sugar level). Additional information on chapter 15 page 101
- How is diabetic kidney disease diagnosed? Which test detects it at the earliest?
There are no symptoms in the early stages of diabetic kidney disease and detection of the disease is possible only with laboratory tests. Two most important tests used to diagnose diabetic kidney disease are the urine test for protein and the blood test for creatinine (and eGFR).
The ideal test to detect diabetic kidney disease at the earliest is a microalbuminuria test of urine. In Type 1 diabetes, this test should be done after 5 years of onset of diabetes and every year subsequently. In Type 2 diabetes, microalbuminuria test should be done at the time of diagnosis and every year subsequently.
In absence of availability of microalbuminuria test, the next best diagnostic test is the urine test for albumin by standard urine dipstick test. Detection of macroalbuminuria by urine dipstick test is a simple and cheap method, which is available even in small centers of developing countries and therefore is an ideal and feasible option for the mass screening of diabetic kidney disease.
Remember that the symptoms of kidney failure - swelling, fatigue and nausea - usually don’t occur until the late stages of kidney disease.
Simillarly, the value of serum creatinine (and eGFR) also increases in the later stage of diabetic kidney disease. So these parameters are ineffective for the diagnosis of the early stage of the diseases. Additional information on chapter 15 page 102
- How to prevent diabetic kidney disease?
Important measures every diabetic should follow to prevent diabetic kidney disease are:
1. Regular follow up with the doctor.
2. Achieving the best control of diabetes. Keep HbA1C level less than 7.
3. Keep blood pressure below 130/80 mmHg. Early use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) group of antihypertensive drugs.
4. Restrict sugar and salt intake and eat diet low in protein, cholesterol and fat.
5. Check kidney at least once a year by urine test for albumin and the blood test for creatinine (and eGFR).
6. Other measures: Exercise regularly and maintain ideal weight. Avoid alcohol, smoking, tobacco products and indiscriminate use of painkillers. Additional information on chapter 15 page 106
- How to treat diabetic kidney disease?
Important measures to treat diabetic kidney disease are proper control of diabetes and blood pressure, early use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are antihypertensive drugs, diuretic drugs to reduce swelling, other supportive medications and dietary restrictions. Additional information on chapter 15 page 107
FAQ - Polycystic Kidney Disease
- How much risk children of a person with polycystic kidney disease carries for the inheritence?
Polycystic kidney disease is an inherited disease in which each child has a 50:50 chance of developing the disease. Additional information on chapter 16 page 111
- How is the kidney affected in PKD?
In PKD, multiple clusters of cysts (fluid-filled sacs) of variable size (diameter ranging from a pinhead to as large 10 cm. or more) are seen in both kidneys. With time the size of cysts increases, which slowly compress and damage healthy kidney tissue. Such damage in long term leads to hypertension and reduction of kidney function, causing chronic kidney failure. Additional information on chapter 16 page 109
- How is PKD diagnosed?
Ultrasound of the kidneys is a most commonly used diagnostic test for PKD. However, CT or MRI scan of the kidneys are more precise, although expensive. Additional information on chapter 16 page 111
FAQ - Living with a Single Kidney
- What problems is a person with a single kidney likely to face?
Single kidney is capable of performing normal functions of both kidneys. So a person with a single kidney does not have any problems in routine or sexual activity or strenuous work. Additional information on chapter 17 page 115
- What precautions should a person with a single kidney take?
Important precautions to protect the solitary kidney are drinking a lot of water, avoiding contact sports which carry risk of injury to the solitary kidney and informing the doctor about the single kidney before any abdominal surgerybefore any abdominal surgery inform the doctor that you have a single kidney. Additional information on chapter 17 page 117
- What is the most common cause of burning or pain during urination?
he most common cause of burning urination is a urinary tract infection. Additional information on chapter 18 page 119
FAQ - Stone Disease
- What are the characteristics of abdominal pain due to urinary stone?
The severity and the location of the pain due to urinary stone vary from person to person depending upon the type, the size and the position of the stone within the urinary tract. Stone pain can vary from a vague flank pain to the sudden onset of severe unbearable pain. Pain is aggravated by change of posture and vehicular jerks. The pain may last for minutes to hours followed by relief. Waxing and waning is the characteristic of the pain caused by a urinary stone. Additional information on chapter 19 page 130
- Can kidney stones damage the kidney?
Yes. Stones in the kidney or ureter can block or obstruct the flow of urine within the urinary tract. Such obstruction can cause dilatation of kidney. Persistent severe dilatation due to blockage can cause kidney damage. Additional information on chapter 19 page 131
- How to treat urinary stones?
The treatment of urinary stones depends on the degree of symptoms observed, size, position and cause of the stone, and the presence or absence of urinary infection and obstruction. Two major treatment options are conservative treatment and surgical treatment. Most frequently used surgical methods are extra-corporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotripsy (PCNL), ureteroscopy and in rare cases open surgery. Additional information on chapter 19 page 137
- Does urinary stone recur?
Yes. Urinary stone recurs in about 50 to 70% of persons. So all patients who have suffered from kidney stone should undertake measures to prevent its recurrence. Additional information on chapter 19 page 132
- What precautions should be taken to prevent recurrence of urinary stone or reduce increment in size of existing urinary stones?
Measures to prevent recurrence of urinary stone or reduce increment in size of existing urinary stones are drinking lots of water and fluids, restricting diet, and taking medications as per doctor’s advice. Additional information on chapter 19 page 132
FAQ - Benign Prostatic Hyperplasia (BPH)
- Which is the most common cause of difficulty in urination in elderly males?
Benign prostatic hyperplasia (enlargement of prostate gland) is the most common cause of difficulty in urination in elderly males. Additional information on chapter 20 page 143
- How to diagnose benign prostatic hyperplasia?
Detailed history, digital rectal examination and sonography are important for the diagnosis of BPH. Additional information on chapter 20 page 145
- How to treat benign prostatic hyperplasia?
Medical treatment is effective in majority of elderly male with mild to moderate symptoms of BPH. While surgical treatment is necessary in people with BPH with bothersome, moderate to severe symptoms refractory to medical treatment. Additional information on chapter 20 page 147
FAQ - Kidney and Drugs
- When can drugs damage kidneys?
Risk of drug induced kidney damage is high in a person with advanced age, kidney failure, diabetes or dehydration. The risk is especially high when the drugs are taken for a long period in high dosage without the supervision of a doctor. Additional information on chapter 21 page 158
- Which drugs carry risk of damage to the kidneys?
Most common agents which carry risk of damage to kidneys are pain killers, amino glycoside antibiotics, Radiocontrast media (X-ray dyes) and natural medicines containing heavy metals and toxic substances. Additional information on chapter 21 page 157
FAQ - Nephrotic Syndrome
- What is nephrotic syndrome?
Kidney works as a sieve (filter) in our body which removes waste products and extra water from blood into urine. In nephrotic syndrome the holes of these filters become large, so protein leaks into the urine. Because of the loss of protein in urine, the level of protein in blood falls. Reduction of protein level in blood causes swelling. Depending on the amount of protein lost in the urine and reduction in protein level of blood, the severity of swelling varies. The kidney function, per se, is normal in most patients of nephrotic syndrome. Additional information on chapter 22 page 162
- In spite of the fact that kidney function remains normal, why parents of a child with a nephrotic syndrome are worried?
Majority of the children with nephrotic syndrome respond well to steroids and there is no risk of developing chronic kidney failure. But in majority of children relapse occurs for many years (throughout childhood) and therefore is a cause of worry to the parents of a child with nephrotic syndrome. It is important to know that children with nephrotic syndrome have an excellent prognosis; complete cure usually occurs between the age of 11 to 14 years and these children lead a normal life as adults. Additional information on chapter 22 page 175
- How is nephrotic syndrome treated?
Important measures in the treatment of nephrotic syndrome are appropriate medicines, treatment of infections and dietary restrictions. Additional information on chapter 22 page 167
FAQ -Urinary Tract Infection in Children
- Why do urinary tract infections require immediate attention and urgent treatment in children?
Urinary tract infection needs urgent attention in children because inadequate and delayed treatment can be dangerous as it will cause permanent kidney damage. Recurrent UTI causes kidney scars which in the long term can lead to high blood pressure, poor kidney growth and even chronic kidney disease. Additional information on chapter 23 page 177
- Why is it important to diagnose underlying predisposing factors of urinary tract infection in children?
Underlying predisposing congenital anomalies or structure abnormalities is responsible for the urinary tract infection in more than 50% of children. Without specific medical and at times surgical treatment of the underlying cause, it is not possible to prevent recurrent UTI and its complications in children. Additional information on chapter 23 page 181
- Which investigations are recommended to diagnose underlying predisposing factors of urinary tract infection in children?
Ultrasound of kidney and bladder, X-rays of the abdomen and Voiding Cystourethrogram(VCUG) are the most important tests to diagnose underlying predisposing factors of urinary tract infection in children. Additional information on chapter 23 page 179
- What is vesicoureteral reflux?
Vesicoureteral reflux (VUR) is the most important cause of recurrence of UTI in children. VUR is a congenital abnormality in which urine flows backwards from the bladder into one or both of the ureters, and up to the kidneys. Additional information on chapter 23 page 179
- How is vesicoureteral reflux (VUR) diagnosed?
Voiding cystourethrogram – VCUG test is the most reliable diagnostic test of vesicoureteral reflux and its severity (grading). Additional information on chapter 23 page 186
- What is Voiding Cystourethrogram test used in children with urine tract infection?
Voiding cystourethrogram - VCUG (previously known as Micturating cystourethrogram - MCU) test is most often needed in the evaluation of urinary tract infection in children. In this special X ray test, the bladder is filled with contrast medium through catheter under sterile precautions. After the bladder is filled, catheter is removed and the patient is asked to pass urine. X rays taken at intervals during urination show outline of the bladder and urethra. This test is helpful to diagnose backflow of urine into the ureters and kidneys (known as vesicoureteral reflux) and the structural abnormalities of urinary bladder and urethra. Additional information on chapter 23 page 179
- How is vesicoureteral reflux treated?
The management of vesicoureteral reflux (VUR) depends on the grade of reflux, age of children and symptoms. Children with mild VUR are treated with appropriate antibiotic to control sepsis followed by long term antibiotic prophylaxis to prevent UTI. Surgery and endoscopic treatment are reserved for severe VUR or for those cases where antibiotics have been ineffective. Additional information on chapter 23 page 187
FAQ - Bedwetting
- Is bedwetting a serious problem in children?
No. Bedwetting is very common especially under the age of 6 years. But/However investigations and treatment are necessary if bedwetting continues after the age of seven or eight years, if bedwetting occurs during the day time or if the child has fever, pain, burning and frequent urination. Additional information on chapter 24 page 194
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