Pediatric Rheumatology and Nephrology in Türkiye | MPGCARE

Joint swelling and kidney problems require different specialist assessments. This page explains both fields in separate sections to help families prepare the right records and appointment. MPGCARE coordinates information and visits with Medical Park and Liv Hospital. The receiving center confirms the specialist, accepted age group, available methods and service scope for each child; diagnosis and treatment decisions belong to the physicians.

Pediatric Rheumatology

A pediatric rheumatologist assesses inflammatory joint disease, autoimmune conditions and autoinflammatory fever disorders. Persistent joint swelling, morning stiffness, limping, unexplained recurrent fever or characteristic rashes may prompt referral. Not every joint pain is rheumatic: infection, injury and other causes must also be considered.

Condition	Symptoms and family concerns	Tests selected by the physician
Juvenile idiopathic arthritis (JIA)	Persistent joint swelling, morning stiffness or limping. Eye inflammation can occur without eye symptoms, so keep scheduled ophthalmology visits.	Joint examination, CBC and inflammatory markers; ultrasound or MRI when useful. ANA, RF or other tests are selected for the clinical question; no blood test alone confirms all JIA.
Childhood-onset systemic lupus erythematosus	Rash, joint symptoms, fatigue or mouth ulcers; kidney involvement may be silent. Report swelling, dark urine or reduced urine output.	CBC, kidney function, urinalysis and urine protein measurement; ANA, anti-dsDNA and complement when indicated. Suspected nephritis requires joint nephrology review; biopsy is considered separately.
IgA vasculitis (Henoch–Schönlein purpura)	Raised purple spots, usually on the legs, joint symptoms and abdominal pain. Kidney changes may appear after the rash improves.	Clinical assessment, blood pressure, urine blood/protein and kidney function. Continued urine and blood pressure monitoring is important; biopsy is reserved for selected questions.
Familial Mediterranean fever (FMF)	Recurrent episodes of fever with abdominal, chest or joint pain. Keep an episode diary and report the family history.	Clinical assessment and inflammatory markers during and between episodes; urine protein monitoring and MEFV genetic testing when appropriate. A genetic result alone does not replace clinical assessment.
Juvenile dermatomyositis	Characteristic rash and weakness, such as difficulty climbing stairs or rising from the floor. New swallowing or breathing difficulty needs urgent care.	Strength examination, muscle enzymes such as CK, selected antibodies and muscle MRI; biopsy only when needed to clarify the diagnosis.
Juvenile localized scleroderma (morphea)	Hard or discolored skin patches, sometimes across a joint, can affect movement and growth. Record changes over time.	Skin and movement examination; ultrasound or MRI for suspected deep involvement, and skin biopsy when needed. Additional assessment depends on the affected area.

Pediatric Nephrology

A pediatric nephrologist assesses kidney function, protein or blood in urine, kidney-related high blood pressure and fluid or electrolyte problems. Structural urinary problems may also need a pediatric urologist; any operation is a separate surgical decision. Lupus or vasculitis with kidney involvement may require both a rheumatologist and a nephrologist.

Condition	Symptoms and family concerns	Tests selected by the physician
Nephrotic syndrome	Puffy eyelids, leg swelling, foamy urine or weight gain from fluid retention. Fever or breathing difficulty needs prompt assessment.	Urinalysis and urine protein quantification, albumin, kidney function and electrolytes. Biopsy or genetic testing is selected for atypical findings or treatment response, not required for every child.
Postinfectious glomerulonephritis	Dark or bloody urine, swelling or high blood pressure after an infection. Reduced urine output is a warning sign.	Blood pressure, urinalysis, urine protein, creatinine, electrolytes and complement; infection-related tests according to history. Biopsy only for selected findings or an unusual course.
Recurrent urinary tract infection	Fever, painful urination, urgency or abdominal/flank pain; infants may feed poorly. An unwell child with fever needs local assessment.	Properly collected urinalysis and urine culture; kidney/bladder ultrasound when indicated. Further reflux or kidney-scar investigations depend on age and infection history.
Vesicoureteral reflux (VUR)	Urine flows backward toward the kidneys; recurrent febrile infections may be a clue, but some cases have no symptoms.	Ultrasound and selected voiding cystourethrography; a kidney scan may answer questions about scarring or function. Nephrology and urology decide the appropriate pathway.
Kidney stones	Flank or abdominal pain, blood in urine, vomiting or urinary symptoms. Fever with suspected obstruction needs urgent evaluation.	Urine and blood tests, usually ultrasound first; further imaging when necessary. Stone analysis and an age-appropriate metabolic evaluation help investigate recurrence risk.
Acute kidney injury	A sudden fall in kidney function can occur with dehydration, severe illness or medicine-related injury. Reduced urine output or a very unwell child needs urgent local care.	Serial creatinine, electrolytes, urine tests, blood pressure and fluid assessment; ultrasound or other investigations according to the suspected cause.
Chronic kidney disease	Early disease may have few symptoms; poor growth, fatigue, swelling or high blood pressure can develop. Keep regular reviews even if the child feels well.	Kidney function and age-appropriate eGFR assessment, urine protein and blood pressure; selected ultrasound, CBC, electrolytes and bone/mineral tests for complications.
High blood pressure in children	Often without symptoms. Severe headache, visual changes or neurologic symptoms need urgent assessment. An adult blood pressure threshold should not be used to diagnose a child.	Repeated measurements with the right cuff and pediatric interpretation; ambulatory monitoring when appropriate, urine and kidney blood tests, and selected imaging.
Alport syndrome	Persistent blood in urine, hearing problems or a family history of kidney disease may prompt investigation.	Urinalysis, urine protein and kidney function, hearing assessment and selected eye examination; genetic evaluation and sometimes biopsy according to the clinical question.

Which specialist should we choose?

For kidney function, urinary protein/blood, swelling or kidney-related blood pressure problems, ask for a pediatric nephrologist. For inflammatory joints, autoimmune disease or recurrent inflammatory fever, ask for a pediatric rheumatologist. A pediatrician can help triage unclear symptoms. Kidney involvement in a systemic disease may require both specialists. Confirm the named physician’s pediatric expertise and the receiving hospital’s scope before travel.

Consultation, tests and procedures are different

The consultation reviews symptoms, growth, blood pressure, medicines and examination findings. Blood/urine tests and imaging answer selected questions; they are not a universal package. Joint aspiration, kidney or skin biopsy and other invasive procedures require a separate indication, discussion of risks and consent. A biopsy, dialysis or operation is not automatically needed because a condition appears on this page. The specialist confirms treatment options and their availability; remission, recovery and permanent results cannot be guaranteed.

How should previous results be sent?

Prepare full dated reports with units and laboratory reference ranges, including older results for comparison. Add urine cultures with antibiotic sensitivities, kidney function and urine protein results, blood pressure/growth records, imaging reports and original DICOM images when available. Include biopsy pathology, discharge summaries and treatment history if applicable. Ask MPGCARE for the agreed secure channel and any translation requirements; do not post a child’s records publicly. The receiving physician decides whether repeat testing is necessary.

Information requested before the appointment

Send age, weight, birth history, symptom onset and duration, fever/joint symptom diary, swelling or urine changes, medicines with doses and allergies. Mention family kidney disease, hearing loss, autoimmune disease or recurrent fever. Share the current diagnosis, response to treatment, local physician details and language needs. Record review supports planning and does not replace an examination.

Important points for families

Keep prescribed medicines and monitoring visits consistent. Do not stop steroids or change immunosuppressants, colchicine or other treatment yourself. Ask the physician before pain medicines, supplements or herbal products; some can affect the kidneys. Infection symptoms during immunosuppression require prompt advice from the treating team.

Keep a record of joint function, morning stiffness, fever episodes, growth, swelling and urine changes. Home urine testing, weight or blood pressure monitoring should follow a clinician-taught plan. Fluid, salt, protein and exercise advice must be individualized; do not apply universal restrictions. Discuss vaccines, eye checks, school participation and emotional support with the team.

When is urgent local assessment needed?

A hot swollen joint with fever, inability to bear weight, severe abdominal pain or gastrointestinal bleeding, difficulty swallowing or breathing, very little urine, rapidly increasing swelling, confusion, seizures or severe headache with visual symptoms needs urgent local care. Fever with flank pain or a markedly unwell infant also needs prompt assessment. Do not wait for an international appointment or transfer. Stable long-standing symptoms or planned result reviews follow the routine pathway advised by the local physician.

Preparation and follow-up in your country

Fasting, medicine changes and preparation for imaging, sedation or biopsy are provided only after the receiving center confirms the child-specific plan. Confirm parental consent, accompanying-parent arrangements and interpreter needs with the hospital.

Before departure, obtain the diagnosis, result interpretation, treatment/monitoring plan, warning signs and emergency contacts. Follow-up at home requires an agreed handover to the appropriate local pediatric specialist and access to the necessary labs and examinations. Eye monitoring, kidney checks or medication-safety tests may continue even when symptoms improve. The physician determines travel fitness and additional visits.

Contact MPGCARE to coordinate a pediatric rheumatology or nephrology assessment. The receiving center confirms the appropriate specialist and written clinical scope for your child.

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