Alexandra Mazo, 32 years old

Graduated from the Moscow Medical Academy named after. Sechenov, Faculty of Training of Scientific and Scientific-Pedagogical Personnel, took short-term advanced training courses in New York, Candidate of Medical Sciences.
Works in the nephrology department of the Scientific Center for Children's Health.

The specialty “pediatric nephrology” does not exist in Russia, therefore, although I am a pediatric nephrologist, I have certificates in pediatrics and nephrology. The most interesting thing for me is the systematic approach: the kidneys are responsible for a lot in the body - the removal of harmful substances, urine concentration, blood pressure, the exchange of sodium and potassium, calcium and phosphorus and many other things, erythropoiesis - therefore, when dealing with the kidneys, I have to understand how the whole body works.

We usually have children with quite rare diseases that are difficult to diagnose and require expensive high-tech examination or treatment. As a rule, they come from other hospitals where they could not be helped. I am interested in making the correct diagnosis for a child with a rare disease. There are perhaps no more than ten such children in all of Russia. It happens that a child arrives like a rag - with a disease that no one can recognize. You make the correct diagnosis, select treatment, and he starts running and jumping. It's a miracle. I believe that we have one of the best nephrology departments in Russia, where they treat according to the same standards as throughout the world, although our technical equipment and availability of the latest genetic research are worse.

It happens that a child arrives like a rag - with a disease that no one can recognize. You make the correct diagnosis, select treatment, and he starts running and jumping.

We try to ensure that children do not feel uncomfortable in the hospital - as much as possible. Children are less afraid if you talk to them - and not only about what hurts, but also about abstract topics, about what interests them. I work with two and sometimes three people at once - a child and parents. Mostly with my mother. Everyone has to explain everything separately, several times. I try to imagine how I would feel if I were in their place.

Children with chronic diseases sometimes need to be treated for 5–10 years, and sometimes for the rest of their lives. This is difficult for both parents and children to understand, and requires repeated repetitions. At first there is a defensive reaction: “No, that’s not it. If you can’t cure it with pills, we’ll try badger fat or homeopathy - and everything will go away.” We have to explain that this will not work, that full treatment is required. The child will take the pills for a long time, several years, but at the same time he will begin to feel normal, will be able to run and jump and will not differ in appearance from healthy children.

The kidneys are a silent organ; they very rarely hurt; this happens when stones pass (renal colic) and with pyelonephritis. At the same time, children more often complain of abdominal pain rather than lower back pain. Kidney diseases progress in different ways. Protein may appear in the urine, then the child swells, and this attracts the attention of the parents. It happens that there is blood in the urine and it turns red - this is a reason to contact a nephrologist. It is important to understand where the red blood cells in the urine come from - from the ureters or from the bladder, and light microscopy of urine (test for dimorphic red blood cells) helps here: after passing through the kidneys, the red blood cells change shape, so they can be easily distinguished. Some kidney diseases can also manifest as rickets, which cannot be treated with standard doses of vitamin D. If a child does not gain weight well, pees and drinks a lot, then this is also a signal that you need to see a doctor.

The kidneys are a silent organ; they rarely hurt

Most often we encounter nephrotic syndrome. Parents notice that the child has swelling in the morning, usually the eyelids and legs swell. Sometimes they think at first that it is an allergy, but at this point you need to take a urine test. If it contains protein, you should consult a nephrologist. Against the background of ARVI and high temperature, small amounts of protein may also appear in the urine. In this case, after recovery, the analysis should be repeated. Previously, the diagnosis of chronic pyelonephritis was often made after one or more episodes of urinary tract infection; now such a diagnosis is made only in special cases.

If the analysis shows too high a level of protein in the urine, the child is prescribed a course of prednisolone. Most people benefit from this treatment, although relapses do occur. If it does not work and the child is prescribed prednisolone again and again, this is bad: corticosteroids, to which it belongs, have a systemic effect on the body: the child stops growing, gains a lot of weight, diabetes mellitus, and ulcerative gastritis may develop. So, if prednisolone does not help, other immunosuppressive drugs are prescribed. These are serious medications that reduce immunity, but do not cause delays in physical development. When leaving the hospital, children always stay in touch with us - to adjust the treatment - and from time to time they come for examination.

Previously, the diagnosis of chronic pyelonephritis was often made after one or more episodes of urinary tract infection; now such a diagnosis is made only in special cases

Quite often, especially before the age of three, urinary tract infections occur, including acute pyelonephritis. This may be due to an abnormal development of the urinary tract, most often with vesicoureteral reflux. Therefore, in case of high temperature, it is important to take not only a blood test, but also a urine test. Painful and frequent urination can also be a symptom of a urinary tract infection.

Parents often resort to herbal remedies when they have infections. But without medical supervision, it can cause kidney damage, and children's kidneys are more sensitive to the herbs than adults and are more easily damaged.

During infection, white blood cells and bacteria may appear in the urine. It is advisable to have a urine culture tested for bacteria and sensitivity to antibiotics before prescribing antibiotics. If there are no bacteria in the analysis, but there is a small number of leukocytes, most likely you did not wash the child well. It is important to remember that we are not treating the tests, but the child, so there is no need to prescribe antibiotics just because leukocytes are found in the urine (but there are no bacteria). First, retake the test, and if the result is repeated, the child needs to be examined. Girls first of all need to go to a gynecologist, because this picture occurs with vulvitis or synechia.

When a child’s general urine test reveals some salts or slight changes in an ultrasound of the kidneys, we like to make a diagnosis of “metabolic nephropathy.” In Europe and the USA there is no such diagnosis. Firstly, based on the results of a general urine test, it is generally inappropriate to judge the presence of salts: there are always salts in the urine, and they need to be looked at in a biochemical analysis in order to understand exactly what salts they are. Secondly, the mere presence of salts in the urine is not a diagnosis. We need to look for the reasons for this, and there can be many of them. Before you do anything, you need to make sure your child drinks more. Depending on age, this can be a liter, or two, or three a day. Then retake the biochemical analysis and, if the salt content in it is still elevated, go to a nephrologist.

Urolithiasis can also have many different sources - you need to understand why it occurs. There is a violation of the metabolism of uric acid, calcium, and oxalates. For example, primary hyperaxaluria is a genetic disease in which the functioning of liver enzymes is disrupted, resulting in the excretion of large amounts of oxalates in the urine. Or a violation of uric acid or calcium metabolism. All this needs to be checked. But in our country, sometimes they find stones or “sand” in the kidneys and, without determining the cause, they begin to give drugs whose effectiveness has not been proven, which are not used anywhere in the world. There are different types of stones that are soluble with different acidity of urine, which is important to consider during treatment, but for all types of stones an increased drinking regimen is recommended.

Children's clinic: Alexandra Mazo