Department of Pediatrics

Skip Navigation

Welcome from the Dean

Dr. Caughman Taylor examines a pediatric patient.

Physicians & Other Providers

The Role Of The Pediatric Nephrologist: Treating Chronic Kidney Disease

Patient Chris Trigg (left) discusses his medications with Dr. Robert Holleman at one of his monthly appointments.

He just wasn’t feeling like himself. Thirteen-year-old Chris Trigg tired easily and felt weak with increasing frequency. At school, his work started slipping.

Trigg never would have suspected that when his parents took him to the doctor he would be diagnosed with chronic kidney disease. Or that seven years later he would require dialysis until he is able to have a kidney transplant.

“Chronic kidney disease can be quite mild and silent in the beginning, and it is often difficult to determine how long it has been going on when a patient is referred to us,” said Dr. Robert Holleman, a clinical assistant professor of pediatrics and a pediatric nephrologist.

Trigg’s medical condition is not a common one among his peers. In fact, there are just four pediatric nephrologists in the state of South Carolina, with two of them at the University of South Carolina School of Medicine. “Relative to the adult population, the incidence of chronic kidney disease in pediatrics is much lower,” said Dr. Holleman.

Dr. Holleman sees Trigg on a regular basis in order to monitor his health status and the medications he is taking. Yet even with consistent medical care, kidney disease can eventually lead to end stage kidney failure as the disease progresses. That’s exactly what happened to Trigg as his kidneys got to the point where they could no longer do their job. A year and a half ago, he became dependent on dialysis to remove the waste products and extra water from his blood.

"The key is to keep him as healthy as possible until he gets his kidney." — Dr. Robert Holleman on patient Chris Trigg

After having a catheter surgically implanted in his abdominal cavity, Trigg began daily peritoneal dialysis at home. Before bed, he connects himself to a piece of equipment. While he sleeps, a solution flows through the catheter, washing the wastes and extra fluid from his blood. “The first time I was very nervous doing it,” recalled Trigg. He initially was fearful of painful infection that could result from the procedure. Yet the teenager found that after two or three days he was comfortable with performing the nightly process.

“Because there is a big risk of infection with peritoneal dialysis, patients are thoroughly trained and have easy access to the physicians and nurses when questions and problems arise,” said Dr. Holleman. While the physician stressed that a trained adult caregiver is a necessity, he noted, “There are some very mature teens that are perfectly capable of performing the vast majority of their treatment on their own with very little supervision.” Chris Trigg has been one of those patients. “He’s a real star when it comes to handling what he needs to do for himself medically,” said Dr. Holleman.

While Chris performs his dialysis at home, some teens undergo hemodialysis at a dialysis center. With the process filtering a teenager’s blood for three hours three times a week, the regimen can be quite disruptive to a regular school routine. “We really make the effort to keep them in school. The notion is to try to maintain some sense of normalcy,” Dr. Holleman said. Yet he added that in many cases homebound instruction is necessary in order to prevent students from falling behind. “We work closely with the schools, social workers, and the dialysis team,” he said.

Teens with kidney disease also have to watch what they eat, avoiding particular foods that can cause a buildup of wastes in their system. “Dietary limitations are a very difficult part of their care,” said Dr. Holleman. Kidney failure brings additional concerns, as teenagers can lose their appetite, have altered taste at times, and get full after much less than they are accustomed to eating. “They can become malnourished, so we have to stay on top of that. To do so within the dietary limitations is tricky,” Dr. Holleman said.

As Trigg manages his diet and undergoes nightly dialysis, he continues to wait for a kidney. The 20-year-old is registered with the United Network for Organ Sharing. When a call comes that a kidney is available from a deceased donor, he will go to MUSC in Charleston for the transplant surgery. “I can’t wait. The doctor told me that with a new kidney I will be like a normal person,” he said.

Meanwhile, Dr. Holleman and Dr. Sakarcan (The School of Medicine’s other pediatric nephrologist) see Trigg once a month. “We’re helping him maintain his health as best we can with dialysis and medications. The key is to keep him as healthy as possible until he gets his kidney,” Dr. Holleman said. The physician stressed that education is crucial while his teenage patients are on the waiting list for a kidney. He uses this time to provide realistic expectations for what to expect after the surgery. “After you get a transplant there is still a fairly intensive care plan that involves multiple medications and frequent clinic visits with blood draws,” he said.

Compliance after transplant surgery can be a problematic issue. Teens sometimes balk at taking the very medications that are crucial to their recovery. “They typically are put on prednisone, which alters your appearance and causes weight gain. That’s hard for a teenager who is concerned about his or her appearance,” Dr. Holleman said. “We explain ahead of time that not taking their medications after surgery means they could lose the kidney they waited so long to receive,” he said.

Dr. Holleman understands that waiting for a kidney is a difficult process for young people to endure. “I can only imagine being a teenager and being tired of dialysis and the restrictions placed on me. If these kids don’t have a relative who can be a donor, they never know when a kidney is coming. Unfortunately there are more patients waiting for transplant than there are organs available; that’s the nature of the organ donation system,” he said.

Trigg is doing well with the wait, although he still tires easily with physical activity. He looks forward to a time when he won’t have limitations on what he can do, and when he can pursue a career in law enforcement. Dr. Holleman looks forward to that time as well. “With a transplant, if all goes well, you walk away with normal kidney function. That’s the ultimate goal.”

Reprinted from Connections newsletter, February 2006

Connections is produced twice a year by University Specialty Clinics ®. Connections articles are copyrighted and may be download and/or reprinted for personal use only. Prior written consent is required in order to reprint or electronically reproduce any articles, graphics, and photographs appearing on the website. For more information, contact Diane J. Epperly, Connections editor, at wordchef@atlanticbb.net .

RETURN TO TOP

USC LINKS: