L ITTLE boys testing whose urine stream has a far-reaching distance is common in many communities in Nigeria. Even as toddlers, it is not uncommon for mothers to have urine spray to their face or chest during diaper change for boys because the pee tends to go up and away from the baby’s body.
Grandmothers also check this out when they go to do omugwo, the traditional Igbo after-birth care to ensure that after birth the woman rests for four weeks while they take over the household chores and childcare. Generations after generation, they teach that a weak strength or speed of urine is bad for boys.
Are mothers right that a child’s urine stream should be strong? What constituents an abnormal urine stream? A urine stream that points up, down or to the side or that dribbles or sprays is abnormal and sometimes maybe suggestive of many things, including an underlying kidney problem in a child.
Children, like adults, can have damaged kidneys. Dr Adebowale Ademola, a consultant, pediatric nephrology at the University College Hospital (UCH), Ibadan, says that in boys when the valve that controls the opening of the urethra, which is the tube that goes from the bladder to the end of the penis, becomes partially blocked, the strength and flow of urine becomes weak.
Ademola, a kidney expert said that in children, a weak flow of urine in boys could be a telltale sign of a kidney problem in children likewise fever, swollen eyes in the morning, fatigue, child not urinating well, burning or pain when urinating and difficulty in controlling urination in children who are mature enough to use the toilet.
Dr Ademola spoke at the 2022 World Kidney Day celebration by the renal unit of the University College Hospital (UCH), Ibadan held at the Akinkugbe Kidney Centre with the theme “kidney health for all.
According to him, “even a child can be born with a kidney problem; an ultrasound scan can detect this. Its care after birth depends on its cause in the baby. Some kidney problems that are present early in life only are discovered at teenager ages.”
He stated that some kidney problems also occur in children due to dehydration arising from diarrhoea, severe bacterial infections (like skin rash and sore throat), malaria and kidney diseases like nephrotic syndrome, a kidney disorder that causes the body to pass out too much protein in the urine.
Dr Ademola stated “diarrhoea can kill fast. A large proportion of the human body is water. The danger of diarrhoea is dehydration. This can cause serious damage to the kidneys. That is why mothers are advised to give oral rehydration solution to children with diarrhoea to quickly replace lost body fluid, thereby preventing dehydration.
“A child with malaria fever needs prompt treatment. We see many cases of severe malaria at the hospital after it has affected the child’s kidneys. The ill child is already passing out coca-cola coloured urine, the eyeballs are yellowish in colour and the child’s eyelids are swollen. Some of these children end up requiring kidney dialysis. And if it is not well managed, the child can die from this complication.”
“It is important to pay attention to skin rash and sore throat in children. Some diseases of the kidney like acute glomerulonephritis start with the child having a sore throat or a skin rash. Thereafter, he starts to pass out dark coloured urine. The drop in the amount of urine excreted subsequently makes the blood pressure go up. Some of them end up also having convulsions.
“It is believed that a little damage to the kidney today and another tomorrow eventually contributes to what causes chronic kidney disease later in life. So we need to be careful about all these.”
Dr Ademola stated, on average he see a case of a child whose kidneys had stopped working every six weeks, which by extrapolation could mean about 200 children in Nigeria that require a kidney replacement. Unfortunately, kidney replacement is not available for children in Nigeria.
However, he declared that there are more children affected by acute kidney injury than a failed kidney. Acute kidney injury occurs over a few hours or days when the kidneys suddenly cannot filter waste from the blood due to a bad infection that reduces blood flow to the kidneys, some medicines, poisons, a sudden blockage that stops urine from flowing out of the kidneys or a heavy blood loss, say from a road traffic accident.
According to him, in addition to addressing the underlying cause, children with acute kidney injury will require fluids, medication and dialysis as a treatment to prevent their kidneys from totally stopping to work.
Many people with kidney disease don’t have symptoms until the damage is very advanced. For most people, blood and urine tests are the only way to know. Howbeit, a healthy diet, increased water intake and regular medical checkups are important for a healthy kidney to prevent further damage to a poor kidney; children are no exception to these.
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