Clinical evaluation of the child with suspected renal disease

Abstract

Renal disease in children may present with overt symptoms clearly associated with the urinary tract, such as the development of macroscopic hematuria or profound oliguria. However, in many instances, symptoms may be very nonspecific or seemingly mild. Children with chronic kidney disease present with a wide variety of symptoms including enuresis, failure to thrive, short stature, lethargy, and pallor. The onset may be silent and the progress insidious, with symptoms only developing late in the disease course. Urinary tract infection in infants and small children may, in contrast to older children, present with nonspecific manifestations including poor feeding, vomiting, irritability, abdominal pain, failure to thrive, lethargy, and restlessness. The possibility of renal disease should therefore be considered in the differential diagnosis of any child presenting to the hospital with acute or chronic symptoms.