Urinary tract disorders, be they anomalies or infections, are an important cause of acute and long-term morbidity in children. These conditions need prompt diagnosis and management, not only to relieve the acute morbidity, but also to prevent the long-term renal damage. This makes diagnostic and therapeutic issues concerning these conditions very important. The most common urinary problem encountered in children is urinary tract infection (UTI), which is usually bacterial in origin. Urinalysis and culture play an important role in the diagnosis of this condition. The treatment consists of prompt and specific antibiotic therapy followed by genitourinary imaging in high risk patients to detect underlying urinary tract anomalies. Vesicoureteric reflux (VUR) is characterized by retrograde flow of urine from the bladder to the kidneys, thereby predisposing it to UTI, and the two conditions together are believed to be associated with renal nephropathy. Patients with VUR have an increased risk of developing hypertension, toxemia of pregnancy, and significant renal damage, including end-stage renal disease subsequently in life. Based on the current literature, the author has enumerated various treatment options available for the different grades of VUR. The urinary bladder is meant to function as a storage organ for urine that empties completely in an appropriate time and place. Any disorder that results involuntary passage of urine or inability to void to completion constitutes bladder dysfunction. Bladder dysfunction is increasingly recognized as a risk factor for UTI and VUR, and a cause for enuresis with daytime symptoms. Its diagnosis requires detailed clinical history and examination, non-invasive urodynamic tests, frequency volume charts, and abdominal ultrasonography to predict the type of bladder dysfunction. The author has emphasized on the importance of multidisciplinary approach in its management, comprising of medications, treatment of any underlying cause, scheduled voiding regimen, clean intermittent catheterization, positive reinforcement and where necessary, biofeedback strategies. The book also contains a chapter on the management and long-term outcome of common kidney and urinary tract anomalies detected on antenatal screening such as unilateral or bilateral hydronephrosis, multicystic dysplastic kidneys, and posterior urethral valves.

With the increase in lifestyle-related diseases like diabetes and hypertension the prevalence of Chronic Kidney Disease (CKD) is increasing exponentially and with it is increasing the burden of its ominous consequence, End Stage Renal Disease (ESRD). While ESRD is no longer a death sentence with the advent of efficient renal replacement therapies and the success of renal transplantation, factors such as high cost of these procedures, limited availability of donated kidneys and not enough number of centers equipped with these facilities puts the effective management of ESRD beyond the reach of an average person many-a-times. Additionally the presence of co-existing diseases that contribute to and sometimes complicate the renal impairment as well as delayed referral of the patients to nephrologists also makes matters worse. ESRD is not just a medical but also a social and economic condition that devastates the person and his/her entire family. Hence, early detection and effective prevention of progression of CKD in early stages to advanced CKD and ESRD is the call of the day. In fact, understanding the pathophysiology of the condition and adopting methods of primordial prevention in populations at risk may be desirable to ensure reduction in the incidence of CKD. In those with established CKD, a proactive approach to manage the disease manifestations and limit the ravages of other comorbidities is desirable. For those in advanced stages of CKD, the institution of an appropriate renal replacement therapy individually suited to the patient keeping in view the medical status, lifestyle requirements, economic viability and social acceptability should be advised. This book will help the reader understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage End Stage Renal Disease with special reference to practical experience of the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.

Childhood Renal Disorders - ECAB - E-Book

The skeleton is a metabolically active organ that undergoes continuous remodeling throughout life. This remodeling is necessary both to maintain the structural integrity of the skeleton and to fulfill its metabolic functions as a storehouse of calcium and phosphorus. Skeletal remodeling can be triggered by changes in mechanical forces or microdamage and by hormonal response to changes in circulating calcium and phosphorus levels. The skeleton also serves as the second line of defense against acidosis, and it is able to liberate buffers in the form of inorganic phosphates. Disorders of Bone and Mineral Metabolism is a multi-authored clinical update that covers all major aspects of bone and its mineral disorders. The first chapter is divided into different sections describing various minerals of clinical importance followed by regulation of mineral metabolism by parathyroid hormone, and vitamin D. There is a very good balance of basic information to act as a primer for the reader and the supporting experimental evidence. The complicated and often difficult topics of mineralization of bone and its regulation and other aspects of mineral metabolism are presented in a particularly clear and interesting manner. A long and useful bibliography follows every chapter. This update contains thorough discussions of the pathophysiology, diagnostic techniques, and therapy of mineral diseases with a wealth of detail. The book is a very useful reference for those interested in bone and mineral physiology and disease, be it a general physician or a nephrologist.

Perinatal medicine encompasses various current topics in fetal diagnosis and management, besides preconception counseling. The concept of preconception counseling and healthcare evaluation optimizes a couple’s readiness for childbearing. This helps to minimize any foreseeable adverse factors through a careful diagnostic review and provision of appropriate intervention and therapy in advance. This has been dealt with in detail. The section on etiology and management aspects of Intrauterine Growth Retardation (IUGR) covers investigation and management of suspected or known fetal abnormalities, placental failure, and fetal growth retardation. Prenatal diagnostic procedures had limited access and safety so far, but this is a thing of the past today, especially after the advent of real-time ultrasonography. It brings an increasingly clearer visualization of the intrauterine space and has vastly broadened the scope for fetal diagnosis and treatment. The currently available ultrasound-guided procedures for fetal diagnosis and therapy are discussed at length in the chapter invasive ultrasound procedures. The discussed invasive ultrasound procedures include amniocentesis, cordocentesis, and chorionic villus sampling, done to detect neural tube defects, fetal lung maturity, and chromosomal abnormalities. The controversies surrounding the evaluation of fetal anomalies by ultrasound procedures are covered at length which we expect would be of special interest to the readers. Opinions abound as well as differ on the interpretation of the findings and counseling of couples, based on the same. This section focuses on the implications of missed fetal anomalies in this background and its impact on pregnancy outcome.