Functional Symptoms in Nephrology: Keeping It In and Letting It Out

Abstract

Lower urinary tract complaints, generally described by the term “voiding dysfunction,” are common in children. While often behavioral and responsive to a number of straightforward interventions, they occasionally signal serious underlying kidney disease. Most children with voiding dysfunction can be diagnosed with a careful history and physical examination and some very minimal further testing. A first morning urinalysis is important for excluding a concentrating defect or proteinuria, either of which could indicate an underlying nephropathy. If there is suspicion of an anatomic abnormality, a renal ultrasound, including views of the bladder before and after voiding, is generally sufficient. Frequent voiding during the day (“functional polyuria”) is often self-limited, although self-hypnosis may be used in difficult cases. Nocturnal enuresis (“bedwetting”) is ultimately self-limited but may be improved by some techniques such as waking or the use of enuresis alarms. The dysfunctional elimination syndrome often includes both daytime urinary symptoms and constipation. Dietary efforts at controlling constipation, along with timed voiding, often bring about dramatic improvement.