Pediatric Renal and Genitourinary Disorders

Flashcards covering pediatric renal and genitourinary disorders including enuresis, cryptorchidism, APSGN, nephrotic syndrome, and hemolytic uremic syndrome.

Enuresis

Bedwetting beyond the age when voluntary control should be acquired.

Sleep theory (Enuresis)

A theory of enuresis where children fall into a deep sleep and wet the bed.

Functional bladder capacity (Enuresis)

A theory suggesting the child does not have a big enough bladder to hold the urine.

Nocturnal polyuria (Enuresis)

Occurs when kidneys do not concentrate urine well because of insufficient release of ADH.

Dysfunctional detrusor activity (Enuresis)

Occurs when the bladder detrusor muscle contracts and causes bedwetting.

Bladder conditioning

Management of enuresis using a bed wetting alarm.

Cryptorchidism

Failure of one or both testes to descend normally through the inguinal canal into the scrotum.

Retractile testes

Bilateral condition where testes move back and forth between scrotum and groin because of an overreactive cremaster muscle.

Anorchism

The complete absence of testes or testicles.

Prematurity link to Cryptorchidism

Testes normally drop into the scrotum in the later months of pregnancy in utero; premature infants may not have reached this milestone yet.

Orchiopexy

Surgical management of cryptorchidism ideally performed by $1\text{--}2$ years of age.

What complication can occur if cryptorchidism is not resolved?

Boys that have surgery after the age of $10$ or never are $6 \times$ more likely to develop testicular cancer.

Hypospadias

Urethral opening located below the glans penis or anywhere along the ventral shaft.

Epispadias

Meatal opening located on the dorsal surface of the penis in males, or abnormal clitoris or labia in females, associated with separation of the pubic bone.

Exstrophy complex

Failure of the abdominal wall and pelvis to close in utero, resulting in organs being exposed outside of the body.

Exstrophy complex Management

Staged repair involving bladder closure and pelvic osteotomy (Stage 1), followed by repair of epispadias and creation of a urethral sphincter (Stage 2).

Acute post-streptococcal glomerulonephritis (APSGN) Pathophysiology

Immune complexes are deposited in the glomerular basement membrane; glomeruli become edematous and infiltrated with leukocytes, occluding the capillary lumen and reducing GFR.

Clinical manifestations of APSGN

Edema, HTN, reduced urinary output, and cola colored urine (blood in urine).

Improved signs of APSGN

Increase in urine output and a decrease in weight.

APSGN Complications

Includes hypertensive encephalopathy, renal failure, pulmonary edema, and heart failure.

Adequate urine output (Infant/Small child)

$\text{Output of } 1\text{--}2\,ml/kg/hr$, calculated by dividing volume excreted in $1$ hour by weight in $kg$.

Nephrotic syndrome Pathophysiology

A disturbance that causes the basement membrane of the glomeruli to become increasingly permeable to protein and albumin.

Manifestations of nephrotic syndrome

Edema (periorbital and ascites), frothy/opalescent urine with decreased volume, proteinuria, hypoalbuminemia, and hypercholesteremia.

First line treatment for nephrotic syndrome

Corticosteroids are used to decrease the risk of relapse.

What medicine is given if relapse occurs?

immunosuppressants

Hemolytic uremic syndrome (HUS) Pathophysiology

Injury to the endothelial lining of the small glomerular arterioles, which become swollen and occluded with deposits of platelets and fibrin clots.

Primary triad of HUS

Anemia, thrombocytopenia, and acute renal failure.

HUS Dialysis criteria

Required for any child who has been anuric for $24$ hours or who demonstrates oliguria with uremia or hypertension and seizures.

Complications of HUS

Bleeding, severe acute renal failure, and seizures.