Swelling of the face or legs, fatigue, frothy or foamy urine should raise concern.

Dear worried family,

The diagnosis of kidney disease may be quite challenging. One may lose up to 80% of kidney function with only very minimal symptoms. The need to drink and pee at night and large water intake may be the only symptoms for years. Fatigue is actually a late symptom. I would seek the attention of your GP or pediatrician. A blood test and a urine test should be done. The most helpful tests in urine would a urinalysis and a microalbumin/creatinine ratio. Especially if protein was found in the urine, this would be concerning and needs to be studied further. For the blood tests, extended electrolytes including a bicarbonate, calcium, magnesium and phosphate level, urea, creatinine and full blood count should be considered. Again, abnormal findings warrant further workup and possibly a referral to a pediatric nephrologist. Unfortunately, you did not specify what exactly the symptoms are, but urinary crystals or kidney stones are also to be considered, and a kidney ultrasound would be helpful.

Kind regards,

Guido Filler, MD, PhD, FRCPC

See your pediatrician