Juan Kupferman MD Pediatric Nephrology DrMDK.com
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Interviewer: Sometimes you go to a pediatrician and the kid’s eyes were a little bit puffy and he is doing a urine, as in wait a minute, the eyes are puffy, why is he doing a urine? And he notices just punching the knee area and he suddenly get to you. Hey I thought I had an eye problem, he looks at the urine and you see the kid, I do not know, this does not make any sense to me, can you make some sense out of this. Interviewee: I will try. The question is why the child has swelling around the eyes. The mother may think it some eye problem or could be an allergy. However, this is a sign of swelling what we call edema and when we have edema, kidneys could be responsible. To make a long story short, the kidney filters the blood but it does not allow the protein to go into the urine. If there is protein in the urine or a huge amount of that in the urine, that means the kidney has a problem, the kidney cannot keep the protein, the protein goes into the urine, the protein in the blood goes slow. When the proteins in the blood go slow, that causes swelling everywhere. The first place or the place where you notice is around the eyes so when you see a child that has swelling around the eyes, think that this could be a kidney problem that the kidney maybe losing protein and that is what we need to address. Interviewer: Are there any other areas you could look for the swelling that also be indicative of this? Interviewee: Well, the swelling can happen in many different areas but you can notice it on the legs, on the feet, the lower extremities, you can see some distention of the abdomen, fluid can accumulate in the abdomen. Interviewer: What? the back or anything? Interviewee: Sometimes yes, sometimes you can have it in the back as well, so everywhere. Obviously, if it is very severe, can also cause swelling of the scrotum, swelling of the genitalia where in females and also can accumulate inside the body but obviously you cannot see that but the fluid can accumulate everywhere. Interviewer: They have trumped this, what is that trunk called where kids have this kind of condition and they get swelling in the eyes. Interviewee: Well, the swelling of the everywhere we call nephrotic syndrome. Interviewer: Nephrotic syndrome, is that a common disease? Interviewee: It is not a common disease but we have to be aware of it. As nephrologists, it is common for us, it is not as common for a general pediatrician, the pediatrician should be aware that a child with a little swelling, they should think first of the kidney because it is an important disease and you need to address it and you need to treat it. Interviewer: It can be true, how do we treat though? Interviewee: The treatment of this nephritic syndrome, usually we give a medication. Interviewer: Any particular hallmark of medicine? Interviewee: We use steroids, we use prednisone. For— Interviewer: That is a good thing because it can stop its causes? Or control it? Interviewee: Prednisone in the majority of children, nephritic syndrome is a huge term with many causes but the most common in children, this happens in children from starting at age 2, age 3, age 4, age 5. They get this nephrotic syndrome where prednisone works very well, stops the protein in the urine, if there is no protein in the urine, the protein in the blood goes up again, holds the system in balance again and the swelling around the eyes and the swelling all around the body disappears and gets better. Interviewer: Is this a life long problem or temporary problem? Interviewee: It is an interesting, it is a good question. In the majority of children, it is not a life long problem but it is not a self limited quick problem. It is not temporary, it may take a while, it may take months, it may take years to resolve. In other words, you treat, it gets better, a couple of months later, that can happen again and it is important for the parents to know that this is a recurrent problem that over the time, over the years it will
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