We are committed to providing excellent, up-to-date, multi-disciplinary care for children with acute and chronic kidney diseases and arterial hypertension. In the process, we conduct 2,500 outpatient and 1,000 inpatient visits per year.

As well as daily clinical duties, all staff physicians actively contribute to undergraduate and postgraduate teaching affiliated with the University of Ottawa Faculty of Medicine while also participating at local, national and international continuing medical education (CME) events.

Our team performs clinical research in the field of bone disease, nephrotic syndrome, complications with post kidney transplantation and arterial hypertension.

The Division of Nephrology is also a strong advocate for improving the transition process to adult care. We strive to educate our patients and their families, ensuring their active involvement in maintaining consistency throughout the entire process of their care.

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

The Division of Nephrology manages all common congenital and acquired kidney diseases in children and youth through a wide range of programs. We provide a full range of renal replacement therapy with the exception of kidney transplantation surgery, although we do provide follow-up care for post-kidney transplantation children.

We perform hemodialysis, peritoneal dialysis, plasma exchange and continuous renal replacement therapy. We also care for children with primary and secondary arterial hypertension. For indicated diagnoses on selected patients, we perform kidney biopsies. This constitutes an important element of our nephrology training program.

Inpatient care

The number of inpatient Nephrology consults for hypertension and the various kidney diseases listed above is approximately 1,000 visits per year.

Outpatient care

The division members see approximately 50 patient visits per week, with a total of 2,500 patient visits per year.

In addition to general Nephrology clinics (four half-day clinics per week), we offer the following specialized clinics:

• Pediatric hypertension clinic - one half-day per week
• Clinic for chronic kidney disease, dialysis and post-renal transplantation - two half-days per week
• Reflux clinic for children with severe vesicoureteric reflux, performed jointly with the Division of Urology - one half-day per month
• Stone clinic for children with kidney stones,performed jointly with the Division of Urology - one half-day per month
• We maintain a dialysis unit equipped with five hemodialysis machines and two machines for continuous renal replacement therapy or plasma exchange. The number of chronic hemodialysis patients ranges from two to 10 per year, with a total of 800 to 900 hemodialysis sessions per year.
• Ambulatory blood pressure monitoring (ABPM) service, equipped with a total of five ABPM monitors (SpaceLabs). We have the ability to provide 24-hour blood pressure assessments for approximately 300 patients per year.

Clinical problems and diseases evaluated and followed

The Nephrology Division is primarily a consulting service (outpatients and inpatients) for the following types of kidney diseases:

Congenital kidney disease

• Kidney malformations (dysplasia, hypoplasia, ectopia, cystic diseases, hydronephrosis)
• Ureter and bladder problems (vesicoureteric reflux, bladder malformations/dysfunction)
• Urethral problems (posterior urethral valves)

Acquired kidney disease

• Urinary tract infections
• Nephrotic and nephritic syndromes
• Glomerulonephritis
• Hypertension
• Kidney stones
• Hematuria
• Proteinuria

All of these diseases are managed in close cooperation with the Division of Urology at CHEO.

Acute Renal Failure (ARF) 

We provide complete care for children with ARF, including conservative management as well as all forms of renal replacement therapy as listed below. This is done in cooperation with the CHEO Intensive Care Unit (ICU). 

Renal Replacement Therapy (RRT) involves: 

• Hemodialysis (HD), both acute and chronic
• Peritoneal dialysis (PD), both acute and chronic
• Continuous renal replacement therapy (CRRT)
• Plasma exchange therapy
• Kidney transplantation 

Chronic Kidney Disease (CKD)

We provide comprehensive care for children with CKD including conservative management and all forms of renal replacement therapy as listed above. If there is a need for renal replacement therapy, children are prepared for either chronic dialysis followed by kidney transplantation or directly for kidney transplantation. Chronic dialysis therapy is provided in our Dialysis Unit at CHEO. 

Kidney transplantation 

Kidney transplants are done in cooperation with the Hospital for Sick Children in Toronto, Montreal Children’s Hospital or The Ottawa Hospital. Two different types of transplants are offered and managed by CHEO:

• Cadaveric where the organ comes from a deceased donor
• Living related where the organ comes from family members

Although the transplant surgery is not performed at CHEO, we provide comprehensive pre-transplant preparation and post-transplant follow-up for our children.

The research activities of the Division of Nephrology are focused on bone disease, nephrotic syndrome, arterial hypertension and complications of post kidney transplant. The CHEO Research Institute offers tremendous support to our trainees through various methodologic workshops.

We participate in national and international multi-centre studies and enroll patients into international registries such as the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) database. Our team members are actively involved in several regional and hospital-affiliated committees. 

Specific areas of research include, but are not limited to:

• Bone disease in children with nephrotic syndrome
• Post kidney transplantation as well as the complications surrounding chronic kidney disease and arterial hypertension
• Vesicoureteral reflux (VUR)
• Anemia in chronic kidney disease (CKD) and studies of renal transplantation
• Developing teaching modules on peritoneal dialysis for the trainees
• Research training focus on Health Educators’ Scholar program (HESP)

Undergraduate training opportunities 

Pediatric Nephrology undergraduate electives prepare students to know the presenting signs and symptoms of common renal diseases in children, including investigation and management. 

First and second-year students observe the nephrology service in both the ambulatory and inpatient locations including hemodialysis, peritoneal dialysis and renal transplantation. 

Third and fourth-year students join the nephrology team in the management of renal problems in children in the ambulatory, renal replacement therapy and inpatient services. Students also participate in ward and teaching rounds as well as generally assist the nephrology resident.

Training opportunities also include:

• A two-week rotation for R3 level clerkship selective medical students
• Participation in weekly clinic schedule
• Attending teaching rounds offered throughout the rotation

Postgraduate training program

The Pediatric Nephrology Residency and Fellowship Program is a two-year, fully accredited Royal College of Physicians and Surgeons of Canada training program. The program prepares eligible candidates for a career in either clinical or research-oriented pediatric nephrology. If a clinical track is chosen, the usual training period is two years. Three years, or more, of training is preferable for a career in research.

The first year is devoted primarily to clinical experience for the trainee to acquire appropriate clinical skills and related basic scientific knowledge. The second year includes various elective months with the goal of also consolidating and finishing a research project. The third year is reserved for a research endeavour.

Throughout the program, tutorials are provided in basic science as well as comprehensive reviews of various pediatric nephrology topics. There is dedicated teaching time on Wednesday afternoons. The resident is expected to take part in critical reviews of the literature and present various topics at rounds and at journal clubs. There is also the opportunity for the resident to attend biopsy rounds and conjoint rounds with urology and radiology.

The program includes a mandatory rotation to the program at the University of Toronto for a one-month of transplant service.

See the full program details at Pediatric Nephrology Residency

Additional postgraduate training

Residents from the uOttawa Faculty of Medicine’s General Pediatrics Residency Program, and residents from other programs both within uOttawa and located at other universities, have the opportunity to undertake a rotation in pediatric nephrology at CHEO. The following elements are included:

• Four-week rotation for R2, R3 or R4 level residents
• Resident will be supervised by the pediatric nephrologists and pediatric nephrology resident
• Both inpatient and outpatient care will be experienced. The rotating resident is the first call for consults in the Emergency Room and on the inpatient unit with responsibility for daily inpatient rounds
• Rotation evaluation will take place at the end of the four weeks 

General objectives of the rotation

• Establish an atmosphere of self-education and self-evaluation, as well as engender attitudes conducive to life-long learning
• Familiarize the resident with the various factors which influence the maturation of renal function in the infant and child, and their various disturbances and clinical expressions
• Familiarize the resident with appropriate clinical workup, including imaging techniques, for various renal disorders
• Acquire expertise in the different modalities in therapeutics of renal disease (both acute and chronic) and the methods for maintenance of life after cessation of renal function
• Develop skills in patient care rapport and empathy in dealing with families with acute and chronic illness
• Acquire skills in self-education, presentations, record keeping and be able to evaluate critically the scientific literature