What to Expect at Kidney Follow-Up Visits after Going Home

The type of doctor who sees your child after going home to follow their kidney function as well as the frequency of clinic visits will vary depending on how severe your child’s episode of AKI was.

• Children with a mild episode of AKI during their NICU admission may be followed by their primary care provider and may not see a kidney specialist (nephrologist).

• In those with more severe kidney injury (such as those who need dialysis), those born prematurely, or those with other health conditions or a high risk of future kidney injury, the team may recommend that a pediatric nephrologist is part of the care team. 

• How frequently your child is seen will depend on a variety of factors including their current kidney function (creatinine at discharge), blood pressure, current medications, and other medical conditions. It is common for children to be seen three to six months after hospital discharge, but this can vary. 

• Additionally, children born very prematurely may see a kidney doctor or their pediatrician to look for signs of CKD during childhood even without any kidney injury. 

There is no one-size-fits-all kidney follow-up visit, as the contents of each visit will depend on how severe the episode of AKI was, the kidney function at the time of discharge and how much time has passed since the last visit. 

Possible elements of the visit include:

Discussion of new issues or concerns

The visit will likely start with an update of how things have been since the last visit or hospital discharge. This will include an opportunity to ask any questions or discuss any concerns. Topics include:

• New medical conditions or hospitalizations, including new episodes of AKI
• New medications
• Family history (especially family history related to kidney disease or high blood pressure)

Physical Examination

This may include height and weight, blood pressure monitoring (often checked several times by several different people) and other vital signs.

Urine testing

We can test for many substances in the urine, which can give us many clues into the kidney’s health. When there is concern for abnormal kidney function, urine testing (urinalysis) is used to test for a protein called albumin. The kidneys normally prevent albumin from leaving the body in urine, because it is an important protein for many body functions like fighting disease and forming muscle and tissue. Albumin in the urine suggests the kidneys are “leaky” and is another sign of acute kidney injury.

• If your child is not potty trained, urine will be collected either from a urine “bag” placed in the diaper.
• If your child is potty trained, urine will likely be collected using a collection container placed in the toilet.

Blood testing

Sometimes blood testing is performed to check kidney function with blood tests called serum creatinine or cystatin C. These are both normal waste products made when muscles are working and are normally removed from the blood by the kidneys and exits the body in urine. An increase above a normal level suggests that the kidneys are not removing these waste products as well as they should be and can be a sign of kidney dysfunction. How high these values are and how long they are elevated determine whether these changes are mild, moderate or severe and acute vs. chronic.

Kidney Ultrasound

Sometimes a kidney ultrasound is performed, which uses a non-invasive probe held on the stomach and/or back to look at the kidneys. Your doctor will review the results of the kidney ultrasound with you. The ultrasound allows us to answer the following questions:

• How well are the kidneys growing?
• How do the kidneys look?
• Are there any structural changes that are seen?

There is no one-size-fits-all kidney follow-up visit, as the contents of each visit will depend on how severe the episode of AKI was, the kidney function at the time of discharge and how much time has passed since the last visit.

How frequently your child is seen will depend on a variety of factors including their current kidney function (creatinine at discharge), blood pressure, current medications, and other medical conditions. It is common for children to be seen three to six months after hospital discharge, but this can vary. We often see children around two years of age to monitor for kidney health. 

Your primary care provider is a very important partner in the care of your child. Your pediatrician may check blood pressures as part of their routine care visits. 

• Children with a mild episode of AKI during their NICU admission may be followed by their primary care provider and may not see a kidney specialist (nephrologist).
• In those with more severe kidney injury (such as those who need dialysis), those born prematurely, or those with other health conditions or a high risk of future kidney injury, the team may recommend that a pediatric nephrologist is part of the care team. 
• Additionally, children born very prematurely may see a kidney doctor or their pediatrician to look for signs of CKD during childhood even without any kidney injury. 

There are many efforts to learn more about the long-term kidney health of children admitted to the NICU. The pediatric nephrology team at IU School of Medicine and Riley Hospital is part of many ongoing projects to try and learn more about kidney health and to improve the long-term kidney outcomes of children.