The Pediatric Nephrology Unit performs diagnosis, treatment and follows-up on patients with urinary tract infections, congenital defects, and other disorders affecting the renal and urinary system. Kidney biopsies are also performed in cooperation with the Ultrasound Unit and the Pathology Institute.

Patients with kidney and urinary tract stones, renal metabolic problems, acquired renal disease, genetic renal disturbances, and acute and chronic renal failure is also treated.

Children up to the age of 18 who suffer from hypertension are referred to the unit for diagnosis, treatment and long-term follow-up.  

We provide many specialty services, such as our dialysis and acute dialysis unit, our clinic for terminal kidney disease and kidney transplant patients and our renal biopsy clinic.  We also have a special clinic for children with Nocturnal Urination Syndrome.
 
Dialysis Unit
Children who suffer from terminal renal failure and require peritoneal dialysis are referred to this unit. During peritoneal dialysis a catheter is inserted into the abdominal cavity, remaining there for a lengthy period of time during which fluid flows into the abdominal cavity via the catheter and a metabolic process is accomplished, toxic waste is removed balancing the system, after which the fluids are drained from the abdominal cavity. Prior to performance of peritoneal dialysis, dialysis unit physicians and nurses offer patients and families complete information regarding the process and then follow up patients post procedure. During their first period of hospitalization these young patient and their families also receive instructions regarding at-home dialysis supervised by a peritoneal dialysis nurse and the adult dialysis unit.

Acute Dialysis Unit    
Infants and children suffering from acute renal failure are treated in this unit. A number of dialysis treatment modalities are used to treat these patients in the Pediatric ICU. Dialysis treatment modalities include peritoneal dialysis, hemodialysis (patient hookup to dialysis machine for removal of waste from blood), and hemofiltration (continuous renal replacement therapy).

Clinic for Terminal Kidney Disease Patients and Kidney Transplant Patients    
Children suffering from chronic and terminal renal insufficiency requiring precise monitoring are referred to this clinic. Unit physicians make recommendations regarding medication and the unit's dietician makes dietary recommendations. A pediatric psychologist prepares children to undergo dialysis or kidney transplant, and follow up is continued after transplant is performed.

Renal Biopsy Service
This service functions in cooperation with the Ultrasound Unit and the Pathology Institute, and treats children with chronic renal disease, requiring precise diagnosis and medication recommendation. Cases involving children with acute renal failure, in which background information to determine possible cause of renal failure is required for diagnosis and treatment recommendation, are also referred to this service.

Laboratory

The Pediatric Nephrology Unit has a special clinic for children with Nocturnal Urination Syndrome.  Nocturnal Urination is a common problem that is embarrassing to the child and a burden on parents. Known by the clinical term nocturnal enuresis, it is manifested by involuntary urination during asleep. When a child is over the age of five, and urinates 2-3 times a week during sleep this is deemed a problem requiring evaluation and treatment. This problem can be treated.

Why is it important to see a doctor? In most cases the problem is physical rather than psychological, and may be genetic. In order to ascertain the source of the problem it is important that a physician with experience in this field evaluates the child and makes treatment recommendations. Neglecting the problem may adversely affect the child, making the child less self-assured and significantly impacting personality development and interaction with surroundings. 

How can we help these children?  A number of behavioral treatment modalities are available that can help in the treatment of this problem. However, the efficacy of these treatment modalities is limited, and sometimes months may go by before any real improvement is achieved.
 
Bladder Exercise: This exercise is based on having the child urinate at predetermined periods of time, with gradually larger periods of time between urination. Exercise strengthens the bladder allowing it to hold a larger volume of urine.

Motivation: In this series of interviews the child is encouraged to take responsibility and an active part in the treatment program, and to help the child deal with guilt, and strengthen the child's motivation.

Conditioning: This method is based on having a bell ring, awakening the child when he or she urinates at night. This kind of treatment is comparatively long-term, and the child may be less motivated toward continuing treatment.  

Medication: Minirin: This drug duplicates the natural hormone that reduced urination at night. Treatment is based on the finding that children who suffer from nocturnal enuresis have a shortage of this hormone. The drug is administered at bedtime by tablet or nasal spray. The drug is highly effective and results are achieved quickly. The drug is usually recommended for a period of six months with gradual tapering off of dosage. It has almost no documented side effects.

Anti-depressants: These drugs act on the central nervous system, and affecting the child's level of consciousness.

Muscles Relaxants: These drugs act on the central nervous system, partially relaxing the bladder wall muscles, and increasing the volume of urine which the bladder can hold.

Unit at a Glance
Number of Outpatients per Year - 1500
Director - Dr. Danny Lotan Dr. Lotan was born in 1946 in Paris. He completed his medical studies cum laude at the Medical School of Tel Aviv University in 1973.  He was a pediatric nephrology fellow at the Children's Hospital, McGill University, Montreal, Canada (1981-83). He has been the director of the Pediatric Nephrology Unit, Sheba Medical Center, the Edmond and Lily Safra Children's Hospital since 1990. Dr. Lotan is board certified in Pediatrics (1979) and board certified in Nephrology (1987), and board certified in Pediatric Nephrology (1993). He is a clinical lecturer at the Tel Aviv University. Dr. Lotan is the Chairman of the Examination Board of Pediatric Nephrology, elected by the Israel medical association Scientific Council, 2001-03. Dr. Lotan is a member of many professional international societies. His clinical and scientific research includes work with: the Pediatric Intensive Care Department on chemokines secretion patterns in children after cardiopulmonary bypass; the Nephrology Institute on Familial Hematuria Syndromes, Heriditary Hypomagnesaemia and Heriditary Renal Tubulopathies; the Fetal Medicine Division on the early development of the fetal kidney and the outcome of fetal hyperechogenic kidneys; as well as, ongoing international research (BMS) on blood pressure reduction with Fosinopril in children and adolescents.
Address - The Edmond & Lily Safra Children's Hospital
E-mail - Danny.Lotan@sheba.health.gov.il
Tel - 972-3-530-2497