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Dr. Paul Zmaj



Specialized care, especially for kids

By Paul Zmaj, MD, and Mihail Subtirelu, MD

If your infant, child, or adolescent develops urinary tract and kidney problems, it’s reassuring to know that pediatric subspecialists at T.C. Thompson Children’s Hospital have the expertise and advanced training for providing the specialized care that your child needs.

Pediatric nephrology addresses kidney diseases such as inflammation and infection, blood and protein in the urine, kidney filtering and transport problems, kidney insufficiency and failure, and kidney stone prevention, as well as high blood pressure or hypertension. 

Pediatric urology deals with surgery of the kidneys, urinary tract, and genitals, including surgery to relieve kidney blockages and correct urinary reflux and genital defects. 

Here is an overview of some pediatric nephrology and urology problems that can be treated at T.C. Thompson Children’s Hospital.


Urinary tract infections (UTIs) are common in children and often require hospitalization. One cause, urinary reflux, allows bladder infections to easily ascend to the kidneys. Kidney infections usually cause back pain and high fevers.

Over time, some children develop a natural resistance to UTIs, and the infections subside. In other instances, infections can be curtailed with more frequent bathroom usage or complete emptying of the bladder. Occasionally surgery is needed to reduce the risk of infection.


Urinary tract problems can cause difficulty with urinary control or appropriate emptying of the bladder. Left untreated, these urinary problems can result in infections. Specialists at Children’s Hospital investigate, treat, and manage problems with incontinence.


Hematuria or blood in the urine may not be obvious to the naked eye but can be detected by urine testing. Causes range from benign (noncancerous) conditions to more serious kidney or urinary tract disease. Evaluating and understanding the cause of hematuria helps to identify children with kidney or urinary tract disease who need treatment.


Proteinuria or high levels of protein in the urine may be benign or temporary, but can also be a sign of serious kidney disease that requires treatment. Some children need a kidney biopsy to diagnose and treat proteinuria. Kidney biopsy is usually a minimally invasive procedure, performed by a nephrologist. In some instances, such as very obese children or children with a single kidney, a urologist will perform an open kidney biopsy.

Kidney disease and growth

The kidneys remove excess liquid and wastes from the blood in the form of urine and keep a stable balance of water, salts, and other substances in the body. Sometimes children develop fluid, electrolyte, or acid-based disorders from defects in the functioning of the kidneys.

Growth problems may occur in children who have these defects or chronic kidney insufficiency or failure. Tests can identify the disease, and appropriate treatments can improve the child’s growth.

Kidney stones

Every year, more and more children develop kidney stones. Though the exact number of cases is not known, stones are more often seen in patients with a family history of kidney stones and those who live in hot, dry climates.  Some medications also contribute to kidney stones. 

Treatments such as minimally invasive surgery can reduce the painful agony of kidney stones. Once retrieved, the stone is analyzed to determine why the stone formed.  Blood and urine tests also help to find the reason kidney stones are formed.  After identifying risk factors, a tailored plan of management is created to prevent more stones.

Kidney failure

Children with acute kidney failure may need lifesaving treatments to replace the kidney function until the kidney recovers. Children with chronic kidney insufficiency or failure may also need treatment for complications.


Hypertension, or high blood pressure, is common in children and adolescents. Children may develop hypertension due to other conditions like kidney disease, although older children and adolescents develop more primary hypertension, especially if other family members developed early hypertension. 

Sometimes children develop hypertension associated with obesity, cholesterol levels, and blood glucose problems – a combination known as metabolic syndrome. Specialized evaluation and treatment of children with high blood pressure is available at Children’s Hospital, including 24-hour ambulatory blood pressure monitoring to rule out “white coat” hypertension.


Prenatal ultrasound images can identify enlarged (hydronephrotic) kidneys before birth. Blockages sometimes cause kidney enlargement, and kidney function in children can decrease if the blockage is not eliminated. Moreover, high blood pressure may result from obstructed kidneys. Pediatric subspecialists evaluate and treat these kidney obstructions in children.

Other problems

Occasionally, genital abnormalities are present at birth or develop during childhood. Surgeries to correct these conditions are performed by a pediatric urologist.


Urologic Procedures

Amar Singh, M.D.
Christopher Keel, D.O.

Pediatric Procedures
Paul Zmaj, M.D.