Welcome to the Division of Pediatric Nephrology and Hypertension. Established in the 1970s, our division provides up-to-date, compassionate, comprehensive, state-of-the-art care to infants, children and teenagers with disorders of the urinary tract, from birth until age 21 years, and also counsels mothers when a kidney problem is discovered during pregnancy. Because kidney disease is often associated with elevated blood pressure, we also specialize in the evaluation and treatment of hypertension. The chief of the division has been listed as one of the “Best Doctors” in New Jersey for many years.
As part of our mission, the division plays an active role in undergraduate, graduate and continuing medical education programs and conducts research activities.
In addition to our experienced, compassionate physicians, the excellent administrative staff and outpatient nurses, we have two superb pediatric nephrology nurses. With many years of expertise, our nurses understand the difficulty that chronic illness presents to the patients and their families. They play a critical role in coordinating care, providing education, guidance and support to patients and families throughout a child’s illness. Compliance with diet and medication is a major issue in the teenage population. Our nurses work closely with these patients, helping to improve their understanding of their medical condition and promoting better adherence.
Good nutrition is important to optimal health and is especially important in kidney disorders. Our pediatric nutritionists, who have expertise in chronic kidney disease, are an integral part of therapy and help to evaluate and counsel our patients.
Kidney disorders may be associated with problems in other organ systems. We work in close collaboration with other pediatric specialists to provide the highest level of care. When patients need to see several specialists, we can often coordinate care and office visits, making visits and testing easier for the patient and families.
We are delighted to be part of the expanding children’s academic health campus in New Brunswick. Our main outpatient program is at the Child Health Institute of New Jersey, a comfortable setting designed specifically for young children and adolescents, where we see patients four to five days a week and hold pediatric kidney transplant clinics twice weekly.
We regularly provide inpatient consultations at The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital and have an outpatient pediatric dialysis center in New Brunswick. Patients who need same-day infusions or procedures are admitted to the same day unit at The Bristol-Myers Squibb Children’s Hospital at RWJUH, staffed by friendly, experienced nurses.
In addition, we have an outpatient center at Jersey Shore University Medical Center and provide care to patients at Matheny School and Hospital, a special hospital and educational center for children and adults with medically complex developmental disabilities.
We work closely with the 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 at BSMCH 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 more than 1,000 videourodynamic studies. Accurate videourodynamics 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.
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 the younger pediatric patient. 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” refers to incidences of elevated blood pressure caused 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.
Our experience has mirrored the results of many studies that demonstrate an increased incidence of kidney stones in the pediatric and the 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 is 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 Kidney Stone Center on the New Brunswick campus.
With early diagnosis and state-of-the-art care, kidney failure can often be prevented, or progression can be slowed. When the condition does progress, renal replacement therapy can return the child to good health and a happy, productive life.
Dialysis is a therapy that removes waste products and extra fluids when the kidneys fail. Some children will only need dialysis until their own 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 who have expertise in pediatrics. Along with the social worker, our child life specialist, who works with patients during the hemodialysis sessions, is instrumental in the adjustment of patients and families to the physical and psychosocial effects of kidney failure. Though 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. Though 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. The 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.
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 more than 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 transplantation for extremely small infants (~ 10 kg or more) and are well-versed in dealing with complex urologic reconstructions and 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.