Reasons some children have kidney failure —Expert

It has become a thing of class, much more than cleanliness for mothers to make their babies wear diapers virtually all through the day. Certainly, diapers are convenient and afford mothers less washing. But allowing time in between change of diapers to check out their urine flow can ensure early detection of telltales of urination problem in children.

No doubt, how a boy urinates is different from that of a girl. For instance, when a newborn baby is on the bed and he wants to urinate or wee and without diapers, it can almost hit the mothers face with the urine. That is normal.

But, urine streams in boys that drib or fan out could be the first telltale sign of a urination problem and could easily be missed by mothers that are too forceful about having their baby boys always being in diapers.

Dr Ademola, a consultant paediatric nephrologist, University College Hospital (UCH), Ibadan, Oyo State, said continual dribbling of urine or even a weak stream during urination in boys could suggest that they were not urinating properly and that is the symptom of a condition medically termed posterior urethral valve.

When boys urinate, they should form a stream. Sometimes when boys compete in school, they want to see whose urine will go farthest. Even when baby on the bed urinates, it can almost hit the mothers face with the urine.

However, where the baby boy urinates and it just falls on the bed, without going far, that is suggestive of a poor or weak urinary steam. That means the force with which the urine comes out is low.

Urine leaves the bladder through a tube called the urethra, which in boys passes through the penis. Rarely, small membranes form across the urethra in boys early in pregnancy, and they can block the flow of urine out of the bladder.

These membranes are called posterior urethral valves and can have life-threatening consequences by causing blockage of normal urine flow interfering with the development of the kidneys.

The backup of urine can damage the bladder, kidneys and other parts of the urinary tract, as it causes the organs to swell. That can lead to the damage of the tissues and cells within the urinary tract.

The severity of posterior urethral valves can vary widely. The more severe cases can sometimes be diagnosed before birth using ultrasound, but the less severe cases may not be diagnosed until a boy is older.

Dr Ademola said other warning signals of posterior urethral valves could include a straining to urinate and wetting the bed or the pants either at night or during the day once a child has been toilet trained.

“Sometimes, the child may strain when he wants to urinate because he needs to push that urine pass that obstruction. So if you find a boy with a swollen abdomen having difficulty in passing urine, the posterior urethra valve is something that one may think about.”

Nonetheless, he said in some instances, the urination problem in boys tends to occur due to an infection in the urinary tract, what is medically referred to as urinary tract infection.

A urinary tract infection is an infection affecting the bladder, kidneys and the tubes carrying urine from the kidneys and bladder.

Sometimes urine blockage is not apparent until a child develops symptoms of a urinary tract infection (UTI), including fever, loss of appetite, bedwetting, frequent or painful urination and cloudy, dark, bloody, or foul-smelling urine.

He declared: “young children may not be able to say that they have pains. So, crying during urination can be a pointer to urinary tract infection.

“Particularly in boys, one of the things to think about is whether there is any abnormality in the urinary tract. Posterior urethral valve is a common one; it is probably the most severe form of abnormality in the urinary tract.”

Dr Ademola, however, bemoans the fact many fathers are unable to recognise common dribbling or fanning urine in their boys and ensure they could be taken to the hospital for treatment.

“In Nigeria, many of such boys are brought to the hospitals from age seven. But it is problem that would have been there for long. It is so easy to miss it because looking at the child; one may assume that all is normal,” he declared.

• My son urinates blood

The expert warned that such subtle signs when detected and treated early can also ensure kidney problem, one of its complications is prevented.

Dr Ademola declared that children too for different reasons also end up with a kidney problem

According to him, causes of kidney failure in children are many and including birth defects, hereditary diseases, infection (like severe malaria and throat infections), systemic diseases like hypertension, injury (including falls) and urine blockage or reflux.

He, however, discouraged the use of herbal preparations in children because usually their compositions are not known and sometimes the additives in them can be dangerous for internal organs of children like the kidney

“For instance, there is a form of kidney failure that follows excessive or massive breakdown of red blood cells like what malaria can cause it.

“Usually when there is a massive breakdown of red cells, the eyes will become yellow. And the person will also start to pass dark coloured urine because the haemoglobin that appears in the blood also gets into the urine. This free haemoglobin damages the cells of the kidney.  And the individual has kidney failure.

“And things like camphor, menthol, naphthalene balls for some children can cause massive breakdown of red blood cells and that may damage the kidneys,” he concluded.