Department of Pediatrics
Department of Pediatrics
The Department of Pediatrics

Pediatric Nephrology and Hypertension

The Department of Pediatrics at the University of Texas Medical School at Houston is dedicated to improving the health and welfare of all infants, children, and adolescents.


Clinic Expertise

We care for children with all forms of kidney disease and hypertension.  We care for children at Children's Memorial Hermann Hospital (CMHH), Lyndon Baines Johnson General Hospital (LBJ), and M.D. Anderson Cancer Center (MDACC) as well as several clinics serving the metro Houston area and much of east Texas.  We provide a multidisciplinary team approach to patient care.  We use disease state management, where we care for the patient in the hospital, in the office, at school, and at home.  We perform a multitude of diagnostic tests, including genetic analysis, urine sediment analysis, and renal biopsy.  For patients with sudden loss of kidney function, we offer acute renal replacement therapy: hemodialysis, peritoneal dialysis, continuous venovenus hemofiltration (CVVH), and slow low efficiency dialysis (SLED).  We work in close affiliation with pediatric urology, pediatric radiology, renal pathology, pediatric cardiology, vascular surgery, and transplant surgery divisions. image

Our nephrologists remain at the forefront of techniques for treatment through research in hypertension, immune mediated kidney diseases, dialysis, and transplantation. Ongoing research studies focus on managing chronic kidney disease (CKD) and high blood pressure.  We collaborate with most national and some international pediatric research networks to better understand how to manage our patients and their disorders.

We provide physician, nursing, and staff support for our patients each summer in Kidney Camp, held at Camp For All. The camp's medical team is equipped to provide care for children with a broad range of kidney disorders, including dialysis.

 

How the Kidneys Work

The kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. They are about the size of a fist and protected by other organs and two of the lower ribs. Normally functioning kidneys serve the body by:

  • Cleaning the blood and removing waste products
  • Balancing water and salt to control fluid in the body
  • Controlling blood pressure
  • Helping to make red blood cells and build strong bones
  • Controlling the amount of potassium, calcium, magnesium and phosphorus in the blood

Nephrology is the study of kidney function and disease.  Nephrons are the basic building blocks of the kidney, and each kidney has about one million nephrons.  Nephrons include a glomerulus, the filter, and a tubule which drains the urine.  Each nephron drains into a collecting duct that eventually becomes the renal pelvis.  Ureters drain into the bladder, and the bladder empties via the urethra.  The word "renal" is an adjective that indicates relationship to the kidney.  For example the renal artery delivers blood to the kidney and the renal vein takes blood from the kidney back to the heart.  A renal biopsy is a sampling of kidney tissue.  Renal replacement therapy is a way of replacing kidney function artificially, also known as dialysis.

To learn more, consider enrolling in Kidney School.

Children's Dialysis

Our Children's Dialysis Unit provides acute or chronic hemodialysis and/or peritoneal dialysis to inpatient and outpatient children from birth to 21 years of age. Many patients are referred to us from the Memorial Hermann Pediatric Nephrology Clinic and from physicians and other hospitals for specialized diagnostic care.

The dialysis unit is equipped to care for children with any medical or surgical problem. Our nephrology nurses are specially trained to work with neonatal and pediatric patients, and they stay current through continuing education. Close collaboration between our nurses and physicians enhances the quality of care our patients receive.

Dialysis is a procedure performed routinely on people with acute or chronic renal failure. It removes waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used to prevent renal failure in children who have been exposed to or have eaten toxic substances. There are two types of dialysis that may be performed on your child: peritoneal or hemodialysis.

Peritoneal Dialysis

Peritoneal dialysis is performed by surgically placing a special soft, hollow tube into your child's lower abdomen near the navel. After the tube is placed, a special solution called dialysate is administered into the peritoneal cavity. This cavity houses the organs of the abdomen and is lined by two membrane layers called the peritoneum.

The dialysate is left in the abdomen for a designated period of time, which is determined by your child's physician. The dialysate fluid absorbs waste products and toxins through the peritoneum. The fluid is then drained from the abdomen, measured and discarded.

We perform two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD).

CAPD does not require a machine. Exchanges, often referred to as “passes,” can be done three to five times a day during waking hours. CCPD requires the use of a special home dialysis machine that performs dialysis automatically, even while your child is asleep.

Hemodialysis

Hemodialysis is performed in the dialysis center of the hospital by trained health care professionals. A special type of access, called an arteriovenous (AV) fistula, is implanted, usually under your child's arm. An external intravenous (IV) catheter may also be inserted, but this is less common for long-term dialysis.

After access has been established, your child will be connected to a large hemodialysis machine that drains the blood, bathes it in a special dialysate solution to remove waste substances and fluids, then returns it to the bloodstream.

Hemodialysis is usually done several times a week and lasts for four to five hours. Because of the length of time required, it may be helpful to bring games or reading material for your child.

Kidney Transplant

A number of diseases can directly damage the kidneys, seriously affecting their functioning.  If damage is severe enough, transplantation may be necessary.  A transplant provides a child with a kidney that can keep up with the demands of a full, active life.  We make it a policy to continuously follow all kidney transplant recipients for the life of their kidney. This policy helps ensure the child’s health and it allows us to follow the long-term outcomes of our patients and better understand the effects of immunosuppressive therapy.  The quality of our follow-up care has resulted in the distinguished recognition awarded to Memorial Hermann’s Organ Transplantation Program.

The United Network for Organ Sharing (UNOS) oversees organ distribution in the United States for liver, kidney, pancreas, heart, lung and cornea transplantation.  Criteria have been developed to ensure that all people on the waiting list are judged fairly as to the severity of their illness and the urgency of their need for a transplant.  People waiting for a transplant are placed on a waiting list and given a status code.  Those placed highest on the waiting list are given first priority when a donor organ becomes available.

Many of our patients have related family members who are interested in donating a kidney to the child with failing kidneys.  Although it is not safe for all people to donate a kidney, those that fit specific criteria often do chose to donate and their remaining kidney keeps them healthy.  This is called a living related donor transplant, and the recipients often get their new kidney without ever needing to go on dialysis for their kidney failure.

Memorial Hermann and Memorial Hermann Children's Hospital, where more than 2,500 kidney transplants have been performed, are nationally recognized leaders in dialysis and kidney transplantation. Our surgeons are specifically trained in pediatric transplantation.  Because every child is unique, every transplant is different.  In collaboration with LifeGift, our area's organ procurement organization, we have been able to provide kidney transplants for about one third of newly listed patients within a year of their registration as candidates for transplantation. 

The Kidney Transplant Clinic is located on the ground floor of Jones Pavilion in Memorial Hermann Hospital. The clinical team includes surgeons, nephrologists, nurse coordinators, pharmacists, dietitians and social workers who make daily rounds using a multidisciplinary approach to patient care.  At referral, children are immediately assigned to a coordinator when they select transplantation as a potential treatment option.  Because children with chronic renal disease require comprehensive coordination, the care coordinator follows each child through the transplant work-up, during the transplant operation and for the life of the transplanted kidney thereafter.  Our “one-coordinator-does-it-all” concept ensures continuity of your child’s care through each stage of the process. Our transplant care coordinators are on call 24 hours a day.