Free to Pee etc.

An Illinois Public Radio story caught my eye on Twitter this week. It dealt with a major player in Chicago charter schools and their disciplinary policies. Limitations on bathroom usage meant many young women were bleeding through the mandatory khaki pants during their periods, a less than ideal situation for all involved:

“We have (bathroom) escorts, and they rarely come so we end up walking out (of class) and that gets us in trouble,” she texted. “But who wants to walk around knowing there’s blood on them? It can still stain the seats. They just need to be more understanding.”

They go on to defend the policy, noting that girls who bleed through their pants can tie a sweater around their waist to cover up the damage. Of course, since this is not a usually acceptable part of the dress code, they then announce the names of the girls who are allowed to wear this aberration.

Yeah, please announce to the world the name of the menstruating students. Nothing about that will make them feel self-conscious or awkward.

I haven’t worried about bleeding through for a while now, but I do worry about bathroom access in schools. As a pediatric nephrologist, I take care of a lot of children who would benefit from easier access to the restroom.

  • First up are those children with frequent urinary tract infections (UTIs). One of our defenses against UTI is completely emptying our bladders on a regular basis. This action flushes out any bacteria that have made their way into the interior space. In addition to that, holding urine can cause the bladder to lose efficient function. Children may not be able to empty completely, meaning bacteria are more likely to get a foothold in the bladder and cause trouble. 
  • Second, we must consider children with constipation. A large wad of poop can put pressure on the bladder, its outlet, and its nerves, preventing proper sensation and function. These children must be cleaned out with aggressive stool softening. How inconvenient if the bathroom escort is not available when the poop is ready to pop! Holding it in not only makes constipation worse but further worsens bladder function and makes UTI likely. Adequate fluid intake can also prevent constipation. 
  • Third, a lot of children get kidney stones. Some of these kids have biochemical problems that can be treated, but even those stone-formers could likely prevent such things if they drank enough water. For adults, we recommend enough water to produce 2 liters (66 oz) of urine daily. This means drinking 2-2.5 liters of fluid. At least part of this should be consumed during the school day, necessitating bathroom use. Kidney stones produce debilitating pain, and in the long-run can lead to permanent kidney damage. 

Other considerations include keeping bathrooms clean and functional and safe.

I would like to declare that all people, even students, have the right to use the bathroom when necessary. Not only is holding pee and poop in harmful, but I cannot imagine being able to learn when I’m worried about losing control or bleeding through my clothing.

Join me in showing support for the right to hygienic elimination! You can buy a “Let Kids Pee” ceramic cup or stainless steel travel mug on Amazon (my design is featured above in this post). You will help support this website and the battle we pediatric nephrologists fight on this front.


When Good Kidneys Go Bad

Perhaps the diagnosis surprised the family. A previously healthy child became more and more fatigued, ultimately resulting in a trip to the doctor and some blood tests. Perhaps it was the long-anticipated-but-dreaded progression of a known condition. Either way, a child’s kidneys have reached the point of  no return. What now?

What level of kidney function requires treatment?

Current dialysis achieves 10-15% of normal kidney function. In the case of a patient with a progressing kidney disorder, planning for replacement of kidney function should begin when estimated glomerular filtration rate reaches 20-30% of normal.

What is dialysis?

Dialysis treatment removes excess fluid and chemicals from the blood by filtering it. The trick is removing enough of things like sodium, potassium, magnesium, phosphorus, and acid without removing too much. Two methods of dialysis exist at this time, hemodialysis and peritoneal dialysis.

Click to enlarge
Click to enlarge


In this form of dialysis, the patient’s blood is taken out of their body, run through an artificial kidney machine, and then returned. Typical treatments take 3 to 4 hours and are performed in a dialysis center 3 days each week. Blood can be accessed using a large intravenous tube in the neck veins or, in adults and larger children, a fistula. A surgeon creates a fistula by connecting an artery to a vein, usually in a forearm. After several weeks, the connecting vessel becomes enlarged. Needles can be inserted and used with the same level of blood flow as the plastic tube. Fistula’s provide better dialysis and have fewer risks of infection than the large intravenous tube.

Some dialysis centers now offer home hemodialysis. Patients’ and their families must learn to stick a fistula and perform the treatments themselves. There are many advantages to this situation, although many centers will not accept children for this treatment option.

Peritoneal dialysis

Peritoneal dialysis involves placement of a plastic tube into the tummy of the patient, the peritoneal space around the bowls. Lots of tiny blood vessels flow through this membrane. By putting fluid in and out of the peritoneal space, fluid and chemicals can be removed from the patient. In children we often use a cycler to do this job. This small machine sits by the patient’s bed and runs fluid in and out while the child sleeps. In another form of peritoneal dialysis, the fluid is changed 4 to 6 times each day over 24 hours.

This type of dialysis is performed by the patient and family at home, so it interferes less with school or work. Monthly lab monitoring and doctor visits are necessary.

What is transplantation?

Ultimately, the goal of nephrologists is to transplant every patient with permanent kidney failure, especially children. A new kidney can be obtained from a healthy relative or other volunteer, or it may be donated by a deceased person. Surgeons can attach the new kidney into the patient, most often in one of the groins. The non-functioning “native” kidneys can almost always remain in place.

Kidney transplant can provide a very normal quality of life, but it is not a complete cure. Patients must take medications to prevent rejection as long as they have the kidney.
These medications can make the patient more susceptible to infections and cancers since they tone down the immune system. Patients with transplants require life-long monitoring of kidney function, medication levels, and other potential side-effects. Despite this list of problems, transplantation is the best therapy for kidney failure and should be the goal for most patients.

A new information sheet about dialysis and transplantation is available on the Information Page of this web site.