Ask if an ultrasound was performed on the infant during the gestational period.

Obstructive uropathy and hypoplastic/dysplastic kidneys are often detected in utero.

Ask if the parent has ever seen the child void, if the child is a male infant. 

Children with posterior urethral valves often dribble, strain, or cry when voiding. Their streams will often appear weak. Sometimes the stream will be thin and will have a very long arch.

Ask how often the infant wets the diaper.

A child with a diaper that is always wet could mean overflow from a neurogenic bladder. It could also indicate a ureter inserting aberrantly into the vagina or distal to the bladder neck. Polyuria is associated with increased urine volumes and can be differentiated from constant urine leaking. Ask if the infant ever is noted to have a dry diaper.

Ask questions regarding a history of possible UTIs.

A urinary tract infection may be a presenting sign for significant urinary obstruction.

Children with hypoplastic/dysplastic kidneys may also have abnormalities of the eyes or ears (e.g. colobomas of the eye or ear tags).

Consider renal involvement in child with a history of these findings

In older children and adolescents the most common cause of renal failure is acquired.

Glomerulonephritis either primary or secondary is the most common cause of acquired renal disease leading to renal failure.

It is also possible that diseases affecting the tubules and interstitium of the kidney may result in renal failure.

Children with pathology primarily affecting this portion of the kidney often have concentrating defects and will exhibit polyuria and polydypsia. They often exhibit failure to gain weight. They may have constipation due to chronic dehydration. They often have salt cravings or will go to unusual lengths to obtain water. They will drink out of the sink, the dog bowel, the bath tub or toilet. They will often show a preference for very cold water. Questions asked in the section on proteinuria, hematuria and hypertension are useful when a glomerulonephritis is suspected.

Ask questions and weight gain and height.  

Growth failure is frequently seen in child with renal insufficiency. Poor weight gain usually precedes short statue in infants with renal failure. Infants and children with chronic renal failure often exhibit feedings aversion.

Ask about a history of metabolic bone disease noted in the infant or child.

The uremic environment often produces osteodystrophy or Ricketts.

Always ask if there has been a history of anemia and/or unresponsiveness to iron therapy. Always think renal insufficiency in a child with normochromic normocytic anemia.

Anemia is associated with advanced renal failure. Sometimes children with renal failure may be treated for anemia for long periods of time before the etiology of the anemia is discovered.

There is an increased incidence of GERD and delayed gastric emptying in infants and children with chronic renal failure.

In any child with significant symptoms, consider chronic renal failure.

Ask about a yellow appearance or shallowness to the skin.

Because of the inability to filter chromogens, a uremic child will often be reported to appear yellow or jaundiced. They even may be evaluated for hepatitis. They do not exhibit scleral icterus.

In advanced stages of uremia, pericarditis or a myocardiopathy may be seen.

Pericarditis may present with fever and chest pain. A myocardiopathy is often associated with long standing hypertension. The symptoms may be fatigue, poor appetite, nausea, ascites, and liver enlargement. It would be very unusual for a child to present with a pericarditis or myocardiopathy due to undiagnosed renal failure.

Developmental delay may be associated with syndromes producing renal failure (Frazer syndrome, Laurence-Moon-Biedl syndrome).

Children with renal failure from early childhood may exhibit certain specific difficulties such as problems with visual spatial reasoning and mathematics.