Nephritis

My mother tells me that I had nephritis as a child of 3. She says that I might need dialysis and a kidney transplant. What is this and what should I do? I feel fine and have not had any trouble since.

Nephritis is a term that means an inflammation of the kidneys. There are many forms of this condition and the outcome varies as to which form it is. As you had yours in childhood and you have had no trouble since it is likely to be “acute post-infectious glomerulonephritis”. In some people with this an infection, commonly Strep. throat or school sores, it triggers a response from the immunological (defence) system to fight the infection. The kidney is not infected but is attacked by the immunological system causing inflammation (the body’s response to any insult).

The good news is that if this is what you had, there is a 90% chance that your kidneys have recovered completely and there should be no problem.

If you want to be certain that you have no problem, your doctor can send some of your urine to see if there are any signs of glomerulonephritis and some blood to see if your kidneys are functioning normally.

Painful foot

My 5-year-old son often complains of a sore left foot. It looks normal and he is generally well with a good appetite. He enjoys school. What could be the cause of the painful foot?

Probably the commonest cause of sore feet is poorly fitting shoes. If this has been checked and excluded, a fracture or a foreign body may be present. So an examination by your doctor and possibly an X-ray would be warranted. He/she can also look for any other causes but these are extremely rare. I can only recall 2 cases where a sore foot (with no other joints involved) was the way a more general disease presented.

Pain around the ankles, especially with feet that roll in could be helped by a podiatrist. However if the pain is in a foot and there is no obvious abnormality would probably represent poorly fitting shoes, a fracture in the foot or foreign body. Plantar warts on the sole of the foot are painful but obvious.

Persistent diarrhoea after gastroenteritis

Our 4-year-old daughter has diarrhoea. It started with vomiting at the time when a lot of her Kindergarten friends had vomiting and diarrhoea with blood in the stools. Everyone else has settled down but our daughter still has diarrhoea and tummy pain. Our doctor has looked for a germ in her bowel but nothing was found. Have you any suggestions?

When diarrhoea is bloody, especially if there is a high fever as well, we think of gastroenteritis germs that are slightly unusual. Blood can occur in any form of “gastro” but it is commoner with the rare germs that cause “gastro”.

Because your doctor has not found a germ I would suspect one called Yersinia. Young children with Yersinia usually settle down in 2 weeks but it can persist and cause on-going diarrhoea and tummy pain. Yersinia does not show up on the standard tests that the laboratory uses to grow the “gastro” germs. To find Yersinia the laboratory needs to be told that your doctor suspects it. They will then test the stool specimen in a different way. I suggest you ask your doctor to send another stool specimen specifically to detect Yersinia.

There are treatments for Yersinia but some doubt whether they clear the germ from the gut faster than nature would anyway. I think if it were my child, I would want to be certain that Yersinia was present before considering treatment.

gastroenteritis

What is gastroenteritis and how should it be treated? One hears so many different opinions.

Gastroenteritis (often called “gastro”) occurs most commonly in the late winter to early summer, although it can occur at any time of the year. It is an infection of the gut but in a previously well child antibiotics will NOT

PRODUCE A QUICKER CURE THAN NATURE.

The major symptoms are diarrhoea and vomiting (D&V). Often the vomiting comes before the diarrhoea by a day or so. There may be some minor tummy discomfort but severe pain makes another cause for the D&V likely. However, by far the commonest cause for D&V is gastroenteritis.

The greatest danger of gastroenteritis is fluid loss leading to dehydration. The child becoming quiet and lethargic suggests that this has happened. This or refusal to drink mean medical attention should be sought urgently.

Parents by administering large amounts of clear fluids can prevent the dehydration in many cases. Food or milky drinks may make the dehydration worse and should not be given. The doctor or pharmacist may recommend and electrolyte mixture that contains easily absorbed sugar and minerals. These will rapidly travel into the body (be absorbed) with the water. This will prevent the onset of dehydration in most cases. The electrolyte mixture is dissolved in a stipulated amount of water and it is most important that these instructions be followed exactly.

Often before dehydration the child may complain that the mixture tastes too salty in which case more water can be added or clear lemonade (&-up etc) can be used instead.

Although al formula and other milky drinks should be avoided, breast-feeding should continue. Breast milk is rapidly absorbed and does not make dehydration worse. It also contains a number of agents for fighting the infection causing the gastro (see a previous answer about breast-feeding), leading to quicker recovery.

If dehydration is significant the child will be admitted to hospital and fluid given by intravenous drip or by naso-gastric tube depending on the severity of the dehydration, age of the child and other factors. A naso-gastric tube is a plastic tube passed through the nose down into the stomach.

Most of the bacteria and viruses that cause gastroenteritis are highly infectious. Hand-washing after contact a gastro sufferer is the best defence against infecting someone else including family members.