Division of Nephrology and Hypertension

We have expertise in the evaluation and treatment of many disorders of the kidney and urinary tract and pediatric patients with hypertension. Some common conditions include:

• High blood pressure
• Urinary tract infections
• Hematuria (blood in the urine)
• Proteinuria (protein in the urine)
• Kidney stones
• Fluid, electrolyte, and acid-base imbalances, including renal tubular acidosis
• Cystic disorders of the kidneys
• Glomerulonephritis
• Nephrotic Syndrome
• Diabetic kidney disease
• Congenital malformations of the urinary tract
• Chronic kidney disease/kidney failure
• Voiding problems, including bedwetting

Kidney Stones

Our experience has mirrored the results of many studies that demonstrate an increased incidence of kidney stones in the pediatric and adult populations. Genetic and dietary factors play a major role in most patients. We see patients with complex medical problems that also increase the risk of stones.

As nephrologists, our role is to prevent stones from developing in patients who are at risk. To accomplish that goal, comprehensive evaluation and dietary management are provided, tailored to the individual. When stone removal procedures are required, we partner with the Division of Urology to provide our patients with state-of-the-art care, such as lithotripsy.

Our pediatric radiologists are available to perform and review imaging of the urinary tract. We are now in the process of developing a comprehensive Stone Center on the New Brunswick campus.

Pediatric Urology

We work closely with urologists and are fortunate to be able to offer our patients the highest level of expertise for even the most complex urological problems. For several years in a row, the pediatric urology program was ranked as a top program nationally by US News and World Report and is the only program in New Jersey to be ranked.

The pediatric urology program is proficient in all aspects of bladder and urinary tract reconstruction, including bladder augmentation with intestinal segments and construction of continent catheterizable urinary stomas.

The Pediatric Continence Center has performed over 1,000 urodynamics studies. Accurate urodynamics are an important part of the evaluation for children with neurogenic bladder problems such as spina bifida and posterior urethral valves to make certain that bladder dysfunction will not harm the kidney. Our urology team also offers routine and complex endoscopic procedures including infant cystoscopy, ureteroscopy, and deflux injection for reflux. 

Hypertension

Elevated blood pressure has become more common in the pediatric and teenage population. Familial predisposition, excessive weight gain, relatively sedentary lifestyle, and dietary factors commonly contribute to elevated blood pressure in this age group.

Kidney problems, medications, hormonal factors, and other underlying conditions are more commonly seen as the primary cause in younger pediatric patients. We have expertise in the evaluation and treatment of elevated blood pressure from all causes, tailoring the evaluation and management to the patient.

White Coat Hypertension is the term applied to elevated blood pressure induced by anxiety.  Ambulatory blood pressure monitoring, where blood pressures are recorded automatically multiple times during the day and night, is the standard way of documenting this pattern of blood pressure elevation. The division continues to provide this diagnostic test, which has proved useful in the evaluation and management of hypertension in the pediatric population.

Treatment for Kidney Failure

With early diagnosis and state-of-the-art care, kidney failure can often be prevented, or progression can be slowed. When it does progress, renal replacement therapy can return the child to good health and a happy, productive life.

Dialysis

Dialysis is a therapy that removes waste products and extra fluids when the kidneys fail. Some children will only need dialysis until their kidneys regain function. Others will require dialysis support until a kidney becomes available for transplantation. Our physicians and nurses will help explain dialysis and discuss the different options available to pick the type that best works for each patient.

There are several forms of dialysis. With hemodialysis, the blood circulates through a filter outside the body. Most patients require treatments at least three times a week at a dialysis center. With peritoneal dialysis, the abdominal cavity, the space where the abdominal organs are located, is used instead of an artificial filter. A surgically placed plastic tube is used for this treatment which can be done at home.

The outpatient pediatric dialysis unit, located at an affiliated center in New Brunswick, is staffed by nurses and social workers with expertise in pediatrics. Along with the social worker, our Child Life Specialist, who works with the patients during the hemodialysis sessions, is instrumental in the adjustment of the patients and families to the physical and psychosocial effects of kidney failure.

While most pediatric patients receive hemodialysis treatment at a specialized center, home hemodialysis is also available. Most patients will receive peritoneal dialysis treatments at home, often at night while they are sleeping. This is the most common type of renal replacement therapy for infants. Although the idea of home dialysis therapy initially sounds overwhelming to most families and patients, the procedure is very safe.

After training, patients and families find that it is much easier than they initially envisioned. Nurses with expertise in this modality of therapy and nutritionists with special expertise in the care of these patients meet with the patients and families regularly. Families always have a person to contact in case of emergency or any dialysis problems. Our physicians work closely with the outpatient dialysis staff to monitor all patients on dialysis.

Kidney Transplantation

Successful kidney transplantation is the goal for patients with irreversible kidney failure.  When patients are promptly evaluated for transplantation, dialysis can be avoided or the time on dialysis minimized. Successful kidney transplantation in pediatrics requires the expertise and dedication of a team of transplant professionals as well as the commitment of the patient and his/her family.

Pediatric renal transplantation is a highly specialized field dealing with complex patients, some with multiple medical issues. Our multidisciplinary team brings extensive expertise in the arena of Pediatric Renal Transplantation with over 50 years of combined experience in pediatric transplantation.

All of our surgeons completed a United Network for Organ Sharing (UNOS) approved fellowship in the care of pediatric patients undergoing renal transplantation, including pre- and post-transplant care. We specialize in the transplantation of extremely small infants, (~10 kg or more) and are well-versed in dealing with complex urologic reconstructions, congenital anomalies as well as the intricacies of dialysis access in this complex population. Patients undergo psychological assessment to ensure they are ready for transplant.