1 / 22

Renal Disorders in Children

Renal Disorders in Children. 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 Website 1 and Website 2 with hypospadias repair. Chordee. Ventral curvature of the penis

Download Presentation

Renal Disorders in Children

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

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. 1140 9th 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

  15. Acute Glomerulonephritis • APSGN most common – 10-14 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. NephroticSyndrome • 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 • 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. Diagnosis • History of S/S • Labs • Urine • Proteinurea >2 gm/day • Specific gravity ↑ • Blood • ↓ serum protein • Hgb/Hct – nl or slightly ↑ due to hemoconcentration • Platelets ↑ and serum Na+ ↓ • Cholesterol ↑

  19. Treatment • Goals: Must try to ↓ excretion of protein & ↓ inflammation • Meds: Corticosteroids till urine is free from protein & normal 10-14 days • Immunosuppressants – Cytoxan • Loop Diuretics – not always effective • During massive edema→ ↓salt • No restriction on water

  20. 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

  21. 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

More Related