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Renal Disorders in Children

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Presentation on theme: "Renal Disorders in Children"— Presentation transcript:

1 Renal Disorders in Children

2 Hypospadias Urethral opening of male is located below the glans or underneath the penile shaft Incidence 1 out of 300 live births Cause unknown Familial tendency Website1 and Website 2 with hypospadias repair

3 Chordee Ventral curvature of the penis
Often accompanies more severe forms of hypospadias Foreskin may be absent ventrally Hooded or crooked appearance of penis Surgical repair

4 Surgical Repair Objectives of repair
Enhance ability to void standing up w/straight stream Improve physical appearance of genitalia for psychological reasons Preserve sexually adequate organ Repair best done between 6-18 mos Before develops body image and castration anxiety Nursing care: Prepare parents w/simple explanations Stent may be placed, but Catheter care essential– discharge instructions Increase PO fluids Loose clothing, no straddle toys, swimming, tub baths, rough play or sandboxes

5 Renal Development in Peds
Fluid larger % of total body wt. GFR not adult level til 1-2 yrs. Short loop of Henle in newborn Less efficient first 2 yrs. No bladder control first 2 yrs. Smaller bladder capacity Newborn production about 1 to 2 mL/kg/hr Child production about 1 mL/kg/hr Shorter urethra

6 Lab & Diagnostic Tests Routine UA Specific gravity pH BUN and Cr IVP
VCUG Ultrasounds Angiography

7 Normal Urinalysis pH 5 to 9 Sp gr 1.001 to 1.035 Protein <20 mg/dL
Urobilinogen up to 1 mg/dL WBC’s: 0—5 NONE OF THE FOLLOWING: Glucose – RBCs Ketones – Casts Hgb – Nitrites

8 UTI Classification Upper Tract: Pyelonephritis, VUR, Glomerulonephritis Typically causes fever, chills, flank pain Lower Tract: Urethritis, Cystitis No systemic manifestations E. coli causes about 80%

9 Upper and Lower Tract UTIs

10 Urinary Tract Infections
Typical Symptoms: (box 30-1, p th ed. Hockenberry) Dysuria Frequent urination (>q2h), foul-smelling urine Urgency Suprapubic discomfort or pressure Urine may contain visible blood or sediment (cloudy appearance) General malaise, poor feeding or appetite, vomiting, fussiness/irritability. Flank pain, chills, and fever indicate infection of upper tract (pyelonephritis)

11 Pediatric Manifestations
Pediatric patients with significant bacteriuria may have no symptoms or nonspecific symptoms like fatigue or anorexia Frequency Fever in some cases Odiferous urine Blood or blood-tinged urine Sometimes no symptoms except generalized sepsis Dx: Hx, PE, UA & culture

12 UTI Collaborative Care: Drug Therapy—Antibiotics
Uncomplicated cystitis: short-term course of antibiotics Complicated UTIs: long-term treatment Trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) or nitrofurantoin (Macrobid) Amoxicillin, Cephalexin, Gentamycin Eliminate cause, ID contributing factors

13 Teaching Enc. freq. voiding & complete emptying ↑ fluid intake
Acidify urine (cranberry juice, Vit. C)-present research does NOT support the efficacy of this. pH needs to be at 5.0 or < in order to have a significant impact on e.coli. (P. 1145) Avoid bubble baths, hot tubs, whirlpools No tight panties or nylon Good hygiene; wipe front to back Void after sexual activity Avoid Constipation

14 Vesicoureteral Reflux (VUR)
Urine swept up ureters w/each void then empties back into bladder (p. 1269) ↑s chance for infections - most common cause of pyelonephritis in children Scarring by 5-6 yrs Dx: ultrasound; cystography; VCUG Tx: continuous low dose antibiotics w/freq urine cultures OR surgical repair with stent placement.

15 Acute Glomerulonephritis
APSGN most common – days after strep infection (skin or throat) Inflammation of glomeruli; damage by antigen- antibody complex ↓ GFR & renal bld flow → HTN & edema Most common s/s: HTN—monitor regularly, edema (periorbital), hematuria/proteinuria Daily wt – IMPORTANT Maintain fluid balance & treat HTN Loop diuretics or anti-hypertensives may be used 1st sign of improvement-- ↑ urine & ↓ wt.

16 Nephrotic Syndrome Glomerular injury → massive proteinuria, hypoalbuminemia, hyperlipemia, edema Other s/s: wt. gain, periorbital edema early in day → ankle edema later in day, anorexia, pallor, fatigue, oliguria (dark & frothy) More common between 2-4 yrs old Compare APSGN with Nephrotic Syndrome—see chart at end of Ppt.

17 Types Most common in peds: MCNS Secondary: result of glomerular damage
Minimal-Change Nephrotic Syndrome 80% of cases – cause unknown Precipitated by viral URI Secondary: result of glomerular damage Acute Glomerulonephritis Collagen Diseases (Lupus) Drug toxins/poisons/venons AIDS, sickle cell, hepatitis & others

18 Nephrotic Syndrome (p. 1155, 9th ed)
Wong 7th ed p. 1276; 6th ed p. 1386

19 Diagnosis History of S/S Labs Urine Blood Proteinurea >2 gm/day
Specific gravity ↑ Blood ↓ serum protein Hgb/Hct – nl or slightly ↑ due to hemoconcentration Platelets ↑ and serum Na+ ↓ Cholesterol ↑

20 Treatment Goals: Must try to ↓ excretion of protein & ↓ inflammation
Meds: Corticosteroids till urine is free from protein & normal days Immunosuppressants – Cytoxan Loop Diuretics – not always effective During massive edema→ ↓salt No restriction on water

21 Nursing Considerations
Monitor for infection (esp. peritonitis) Monitor for side effects of steroids Monitor wt, I & O, abd. girth Urinalysis for albumin Protect skin from breakdown d/t edema VS for signs of complications Monitor diet restrictions Support and educate family

22 Prognosis If diuresis within 7-21 days – GOOD
If not after 28 days → chance of response ↓ 80% OK 50% relapse after 5 yrs 20% relapse after 10 yrs Key: early ID and Tx If responds to steroids, relapse is less

23 Minimal Change Nephrosis
Manifestations Acute Glomerular Nephritis Minimal Change Nephrosis ASO Titers Normal BP Normal or  Edema Primarily peripheral or periorbital Generalized, severe Circulatory congestion Common Absent Proteinuria Mild –moderate Massive Hematuria Gross or microscopic Microscopic or none RBC casts Present Azotemia Serum K+ levels Normal or  Serum Protein levels Minimal reduction Markedly  Serum lipid levels Elevated Peak age at onset (Yr) 5-7 2-3

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