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April 2014 - Volume 10 - Issue 10

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The Role of a Pediatric Nephrologist

According to Taber’s Cyclopedia Medical Dictionary, “Nephrology” is the branch of medical science that deals with the structure and function of the kidneys and the prevention and treatment of kidney disease (2005). This specialty is extremely comprehensive because in order to maintain homeostasis in the body, the kidneys have to fulfill a wide array of duties. For instance, the kidneys are not solely required to excrete toxins through the urine. They are also responsible for the somatic control of water, electrolytes, pH, blood pressure, the production of erythrocytes, among others.
 
A Pediatric Nephrologist (Pedneph) has many responsibilities: To diagnose and treat diseases in the urinary system, to perform kidney biopsies in order to better understand kidney disease and its prognosis and treatment. Furthermore, a Pedneph is required to interpret radiographic and nuclear medicine studies, as well as demonstrate specialized knowledge of dialysis and kidney transplantation when end-stage renal disease (ESRD) in children is observed.
 
With the many advances of therapeutic maneuvers to treat ESRD, a Pedneph is involved in different dialysis modalities: Hemodialysis, Peritoneal dialysis, and the continuous renal replacement therapy. This last modality is most commonly observed in the intensive care unit. Kidney transplantation is a very frequent procedure nowadays. The Pedneph’s role within this procedure is to evaluate the patient, and control and check for the effectiveness of both the procedure, and the immunosuppressive drugs.
 
Pedneph has a lot of ethical and legal activities in his/her medical activity. This specialty can be involved in cases in which difficult ethical decisions should – and are - made. The majority of cases are shared with some other specialists like urologists, rheumatologists, pathologists, hematologists, radiologists, psychologists, intensive care medical doctors, etc.
 
The relationship between a Pedneph and a patient and his/her family members is very complex because of the typical chronicity or prolonged condition of many diseases associated with the urinary system. Many patients are required to undergo a physical examination, evaluation, and treatment frequently. The renal patient is fragile and many diseases have prolonged treatment, or incomplete treatment effectiveness with the associated important side effects of the drugs used.
 
When a diagnosis of ESRD is formulated, a Pedneph is required to be constantly aware of the psychological disarrangement among the family members but most importantly between the child’s parents. According to Tong et al “the four major themes pertaining to parental adjustment to ESRD: 1-Parents struggle to accept the diagnosis and feel traumatized with the invasive treatments. 2-Parents
become “medicalized”, feeling that they are responsible for treatment complications. 3-Tensions between the child’s parents might result in sibling neglect. 4-Dependence on support from health professionals and reliance on learning from other parents of similarly sick children.”
 
A prospective study recently published studied the spousal and parent-child relationship in 19 consecutive families with a young child with ESRD. The length of treatment was variable. It took place at the Children’s Hospital, Helsinki University Hospital: This study concluded that the spousal relationships were mostly good or fairly good, and no divorces had occurred. According to Laakkonen et al, “Nearly all parents expressed a good degree of emotional warmth toward the child, expressed criticism was comparable to that found among controls, and hostility was considered absent”. It was stated that it is necessary a longer follow-up period of evaluation and more number of cases to be studied in spite of this study’s findings, it is important to note that a Pedneph is frequently involved in family difficulties where divorce and family imbalances are caused by the child’s diagnosis of ESRD. These characteristics depend on many variables like length of spousal relationships, level of parent’s education, number of children at home, socio-economic status, etc.
 
In conclusion, a Pediatric Nephrologist is a medical specialist responsible for the care of many chronic patients with frequent invasive procedures that bring emotional consequences, dependence, and challenging decisions.
Dr. Carlos Cuervo, Pediatric Nephrologist, Department Head of the Allied Health Division at FNU and a Voluntary Pediatric Faculty at University of Miami, can be reached at ccuervo@fnu.edu.
 
Works cited:
Taber’s Cyclopedic Medical Dictionary (2005) 21stEdition. F.A. Davis Company. Philadelphia
Tong A, Lowe A, Sainsbury P, Craig JC (2010) Parental perspectives on caring for a child with chronic kidney disease: an in-depth interview study. Child Care Health Dev. 36:549-557
Laakkonen H, Taskinen S, Ronnholm K, Holmberg C, Sanberg S (2014) Parent-child and spousal relationships in families with a young child with end-stage renal disease. Pediatr Nephrol. 29:289-295
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