Holding in Urine Until… Kidney Pain!

Recently, hospitals have seen a significant increase in the number of pediatric patients admitted for kidney-related illnesses, including many who have progressed to the final stages of their conditions. Unfortunately, many children suffer from kidney diseases that could be preventable or identifiable at an early stage, but they have been overlooked.

School-age Children at Higher Risk

Patient V.T.T. suffering from end-stage kidney failure treated at Children’s Hospital 1 before passing away (Photo: L.TH.H)

At the end of March, in the nephrology department of Children’s Hospital 1 in Ho Chi Minh City, we witnessed the final moments of patient V.T.T. (13 years old, from Lam Dong). V.T.T.’s eyes were dull, and her hands and feet were pale, with many bruises on her body due to end-stage kidney failure. She could not lie down and could only sit, gasping for breath.

Her father shared that she had been ill for three years, and despite seeking treatment everywhere, they were unable to save her. In the nephrology department, we encountered many children with swollen faces, and several boys had distended genitalia due to water retention…

Dr. Huỳnh Thoại Loan, head of the nephrology department, reported that on March 28, there were 40 pediatric patients with severe kidney disease in the department, and the hospital is currently managing 2,200 children with kidney issues. In 2005, the nephrology department received 276 cases of nephritis, 510 cases of nephrotic syndrome, 275 cases of lupus nephritis, and 98 cases of urinary tract infections… Among these, 50 children had progressed to end-stage renal disease, requiring lifelong dialysis.

According to Dr. Thoại Loan, kidney diseases are relatively common in children, especially those in school from grades 1 to 9. Treatment can be relatively straightforward if the disease is detected early. There are two types of kidney diseases: congenital and acquired. Congenital kidney diseases arise from urinary tract malformations present at birth, such as children born without kidneys, with a single kidney, double kidneys on either side, or hydronephrosis. The remaining 70% are due to acquired kidney diseases.

Among children with acquired kidney diseases, the most common cause is nephritis. Children may develop nephritis as a result of infections; from immune mechanisms such as nephrotic syndrome; from lupus nephritis—a form of systemic disease where the body produces antibodies against its own organs; or from urinary tract infections.

Risk factors for urinary tract infections include children frequently holding their urine, drinking little water, and not maintaining hygiene after urination—particularly among girls. If urinary tract infections recur frequently, they can lead to urinary tract infections (infective nephritis), causing scarring on the kidneys. If not treated promptly, this could lead to chronic kidney failure, sometimes manifesting 20-30 years later.

Younger Children Experience More Severe Kidney Damage

Dr. Thoại Loan noted that children typically urinate approximately every three hours (about 5-6 times a day, excluding sleep hours). However, many children often hold their urine or hesitate to drink water due to fears of needing to urinate, which their parents may not realize. Many children with urinary tract infections respond to doctors’ questions like, “Do you urinate often? How many times a day do you go?” with:

“The school restroom is very dirty; I don’t dare to go,” or “At my school, boys and girls share the same restroom, which is awkward, so I hold it until I get home.”

The unsanitary conditions of restrooms in many schools, along with overcrowding and insufficient facilities for students, are among the factors forcing children to hold their urine. Some students report that during class, when they ask to leave to use the restroom, teachers deny them, telling them to wait until recess.

According to Dr. Thoại Loan, approximately 8% of all girls will experience at least one urinary tract infection during their first twelve years of life. Younger children (ages 1-5) who frequently suffer from untreated urinary tract infections are at a greater risk of kidney damage, and any damage that occurs will often lead to more severe long-term consequences.

Prevention is Not Difficult

In the early stages, the symptoms of kidney disease can be quite vague and can be easily overlooked if parents do not pay attention. To detect issues early, it is essential to monitor a child’s urination habits regularly. Children aged 3-15 should produce an average of 0.5-1 liter of urine per day, which should be light yellow in color.

If parents notice a sudden change in their child’s urine volume, a decrease in frequency, changes in color (cloudy, dark yellow, red), intermittent urination, weak urine stream, or prolonged incontinence, they should take their child to the hospital for a urine test. Parents should also pay attention to any sudden weight gain in their child (such as a 2 kg weight increase in one month), accompanied by swelling of the body or eyelids upon waking up, and seek medical attention promptly.

To prevent acquired kidney diseases, Dr. Thoại Loan advises maintaining personal hygiene for children, including cleaning the nose, throat, and skin. Encourage children to brush their teeth daily. To prevent urinary tract infections, it is important to ensure children drink plenty of water, allow for unobstructed urination (urinate when the urge arises), and practice good personal hygiene.

School administrations should pay attention to restroom conditions, especially for elementary school students, ensuring that children do not have to hold their urine due to unsanitary restrooms or insufficient facilities. In the long term, mandatory urine testing and ultrasounds should be considered as part of children’s enrollment records. In the meantime, if possible, parents should have their children undergo urine tests and ultrasounds at least once a year.

LE THANH HA