8. Kidney Failure

what kidney functions are impaired in kidney failure?

• concentrating urine

• conserving electrolytes

• excreting waste products

how do acute kidney injury and chronic kidney disease differ?

• acute kidney injury: sudden and often reversible

• chronic kidney disease: gradual, permanent, and progressive

what most commonly causes acute kidney failure in children?

decreased renal perfusion, often from severe dehydration caused by gastroenteritis

what GU disorders can progress to acute kidney injury?

• APSGN

• severe nephrotic syndrome

• severe bilateral pyelonephritis

what’s the primary warning sign of impending acute kidney injury? *

sudden oliguria

• urine output less than 1 mL/kg/hr is concerning

what complications can occur with acute kidney failure?

• anemia

• hyperkalemia

• hypertension

• pulmonary edema

• cardiac failure

• altered LOC or seizures

what are the treatment goals for acute kidney failure?

• treat the underlying cause

• manage fluid and electrolyte disturbances

• decrease blood pressure

what most often causes chronic kidney disease in children?

prolonged urine backup damages renal tissue

• congenital structural defects

• recurrent UTIs can cause renal scarring

what major effects of chronic kidney disease should the nurse monitor in children?

• growth failure * and weak bones from impaired vitamin d activation

• severely anemia from decreased erythropoietin production

• hyperkalemia, which can cause lethal arrhythmias

what long-term treatment may be needed for chronic kidney disease?

dialysis or renal transplantation

what happens in testicular torsion?

the spermatic cord twists, cutting off blood flow to the testicle

• SURGICAL EMERGENCY

what can testicular torsion cause?

testicular necrosis and gangrene

what findings suggest testicular torsion?

• sudden, severe unilateral scrotal pain

• significant swelling

• red, hemorrhagic, or blue-black appearance

• absent cremasteric reflex

how is the cremasteric reflex assessed?

stroke the inner thigh and observe for the testicle on the same side to rise

• absent with testicular torsion

what test confirms testicular torsion?

ultrasound

how urgently does testicular torsion require treatment?

immediate surgical correction, ideally within about 6 hours of onset; delay decreases the chance of saving the testicle

what nursing care follows surgical correction of testicular torsion?

routine postoperative care