L5-Genitourinary and Renal Disorders

What is the primary function of the kidneys?

Maintain composition + volume of body fluids through:

• Reabsorption

• Secretion

• Excretion

Where does filtration occur in the kidney?

Nephron

What 3 humoral substances do the kidneys produce?

• Renin

• Erythropoietin (EPO)

• Calcitriol (vitamin D)

What does renin do?

BP/fluid regulation

What does erythropoietin (EPO) do?

stimulates RBC production

What does calicitriol (vitamin D) do?

calcium/bone regulation

What can kidney failure in children lead to?

• HTN

• anemia

• bone/growth problems

Define polyruria, oliguria, and anuria

• Polyuria = ↑ urine

• Oliguria = ↓ urine

• Anuria = no urine

Define hematuria

blood in urine

What is proteinuria?

Protein in urine

What is azotemia?

Nitrogenous waste in the blood

What should NOT normally be present on urinalysis?

Blood, protein, glucose, WBCs, ketones

What is the normal urine specific gravity range in this lecture?

1.005–1.025
Ideal: 1.010

What is cystitis?

Bladder infection (lower urinary tract infection)

What are the S/S of cystitis?

fever, irritability, poor feeding, vomiting, dysuria, urine odor/color changes, hematuria, abdominal pain

What is pyelonephritis?

kidney infection (upper urinary tract infection)

What findings distinguish pyelonephritis from a lower UTI?

fever, back/flank pain, CVA tenderness, nausea/vomiting, child appears sick

What is CVA (Costovertebral angle) tenderness associated with?

Pyelonephritis

How can UTIs be prevented in children?

• Adequate fluids

• Void frequently

• Avoid bubble baths

• Cotton underwear

What is the most important host factor influencing UTI occurrence?

Urinary stasis

What UA finding would be expected with a UTI?

Pyuria = WBCs in urine

What is vesicoureteral reflux (VUR)?

Retrograde flow of urine from the bladder into the ureters

Why does VUR increase UTI risk?

Urine flows backward toward the kidneys, increasing infection risk.

What infection is associated with APSGN?

Group A beta Streptococcus

What causes kidney damage in APSGN?

Immune complexes deposit in the glomeruli → inflammation + damage → filtration becomes impaired → RBCs and protein leak into urine

What are the S/S of APSGN?

oliguria, hematuria, tea-colored urine, periorbital edema, hypertension, fatigue, feels sick, anorexia

What does the urine look like with APSGN and why>

Smoky/tea-colored → RBCs are leaking through the damaged glomerulus

What labs are associated with APSGN?

• Hematuria

• Proteinuria

• ↑ urine specific gravity

• ↑ BUN/Cr

• ↑ ASO titer

• ↓ C3

What does the ASO titer help identify in APSGN?

recent streptococcal infection

What are serious complications of APSGN?

• Hypertensive encephalopathy

• Cardiac decompensation

• Pulmonary edema

What diet is associated with APSGN?

Low Na + low K
- May restrict protein if severe.

What medications can treat HTN with APSGN?

• ACE inhibitors: captopril, enalapril

• ARBs: valsartan, losartan

What is the most common nephrotic syndrome in children?

Minimal Change Nephrotic Syndrome

Who commonly develops minimal change nephrotic syndrome?

Male, preschool childrren, often after a viral URI

What are the FOUR classic findings of nephrotic syndrome?

• Massive proteinuria

• Hypoalbuminemia

• Hyperlipidemia

• Edema

What is the major urine finding in nephrotic syndrome?

Massive proteinuria

Why does nephrotic syndrome cause hypoalbuminemia?

Albumin is lost in the urine.

How does nephrotic syndrome cause edema?

Glomerular injury → protein leaks into urine → blood albumin decreases → fluid doesn’t stay in bloodstream as effectively → fluid moves into tissues → edema

• Protein loss → ↓ albumin → fluid moves into tissues → edema

Where can edema occur with nephrotic syndrome?

Generalized, facial, and periorbital

What medications are used for nephrotic syndrome?

• High-dose corticosteroids

• Immunosuppressants

• Diuretics

What nursing intervention is especially important with nephrotic syndrome?

Strict I&O

Tea-colored urine + HTN + periorbital edema after strep = ?

APSGN

Massive proteinuria + hypoalbuminemia + hyperlipidemia + generalized edema = ?

Nephrotic syndrome

What's the easiest way to distinguish APSGN from nephrotic syndrome?

APSGN = BLOOD + BP
Nephrotic = PROTEIN + PUFFINESS

What happens to ADH in diabetes insipidus (DI)?

↓ ADH / undersecretion

What are the classic manifestations of DI?

• Polyuria

• Polydipsia

• Enuresis

Why does DI cause polyuria?

↓ ADH → kidneys don't retain enough water → ↑ urine

What medication is used diagnose DI?

Desmopressin (DDAVP)

What happens to ADH in SIADH?

↑ ADH / oversecretion

What is the classic SIADH lab pattern?

• ↓ serum Na⁺

• ↓ serum osmolality

• ↑ urine osmolality

Why is serum sodium low in SIADH?

Excess ADH → retain water → sodium becomes diluted

• ADH can retain water independently of sodium, which is why excess ADH can cause hyponatremia.

What neurologic manifestations can occur with SIADH?

Confusion → seizures → stupor

Why can SIADH cause seizures?

Water retention → hyponatremia → brain cell swelling → seizures

What nursing care does the lecture emphasize for DI/SIADH?

• Daily weights

• Strict I&O

• Fluid/diet restrictions

What is the ADH memory trick for DI vs SIADH?

DI = ↓ ADH → DRY → lots of urine

SIADH = ↑ ADH → SOAKED → retain water

A child is diagnosed with hemolytic uremic syndrome (HUS). Which three findings make up the classic triad?

• Acute renal failure

• Thrombocytopenia

• Hemolytic anemia

What infection is associated with diarrhea-positive HUS?

Shiga toxin-producing E. coli → diarrhea

A child with HUS has decreased urine output. Which component of the HUS triad explains this finding?

Acute renal failure — kidney dysfunction causes decreased urine output and fluid/electrolyte problems.

A nurse assesses a child with HUS and notes petechiae and purpura. Which laboratory abnormality is most likely responsible?

Thrombocytopenia (decreased platelets).

A child with HUS appears pale. Which component of the triad explains this assessment finding?

Hemolytic anemia — destruction of red blood cells causes anemia and pallor.

Which assessment findings should the nurse associate with thrombocytopenia in a child with HUS?

Petechiae, purpura, and bleeding.

A child with HUS has a low hemoglobin level. What is the underlying cause?

Hemolysis (red blood cell destruction).

What are the 3 categories of AKI?

Pre-renal, intrinsic, post-renal

What is pre-renal AKI?

↓ renal perfusion

What can cause pre-renal AKI in children?

Dehydration from diarrhea or persistent vomiting

What is intrinsic AKI?

Damage to the glomeruli, tubules, or renal vasculature

What is post-renal AKI?

Urinary obstruction

Define the numerical range for oliguria in pediatric AKI?

<1 mL/kg/hr

What are manifestations of AKI?

Oliguria, Edema, HTN, Heart failure/arrhythmias, Seizures, Pulmonary edema

What is the classic AKI lab pattern?

↑ BUN
↑ Creatinine
↑ K⁺
↓ Na⁺
↓ Ca²⁺
Metabolic acidosis

Why is hyperkalemia dangerous in AKI?

Renal failure → can't eliminate K⁺ → hyperkalemia → cardiac dysrhythmias

What diet is used for AKI in the lecture?

High carb/fat + low protein, Na, and K

AKI vs CKD

AKI = sudden, whereas CKD = slow, progressive nephron destruction

What major problems result from CKD?

waste retention, water/Na retention, hyperkalemia, acidosis, calcium/phosphorus disturbances, anemia, growth disturbance

Why does CKD cause anemia?

Kidney dysfunction → problems with EPO production → ↓ RBC production

What medication treats anemia in CKD?

Erythropoietin (EPO)

What treats growth disturbance in pediatric CKD?

Human growth hormone

What treatments are listed for osteodystrophy in CKD?

Calcium carbonate + vitamin D

What treatment is listed for acidosis in CKD?

sodium bicarbonate / calcium carbonate

What clinical manifestations are associated with CKD?

• Low energy

• Growth disturbance

• Pallor

• Pruritus

What are the characteristics of Hemodialysis?

o   Requires vascular access and dialysis machine

o   3x/week for 4-6 hrs

o   Major advantage: rapid correction of fluid/electrolyte abnormalities

What are the characteristics of peritoneal dialysis?

o   Uses the abdominal/peritoneal cavity as a semipermeable membrane

o   Warmed dialysis solution enters abdomen by gravity → dwells → is removed

o   Can be managed at home

What is phimosis?

Narrowing of foreskin opening

What is a hydrocele?

Fluid in the scrotum

What is cryptorchidism?

Undescended testicle(s)

What is hypospadias?

Urethral opening below/behind the glans

What is epispadias?

Failure of the urethra to close properly

What is bladder exstrophy?

Bladder protrudes/extrudes through the abdominal wall

What GU defect is commonly paired with bladder exstrophy?

Epispadias

What is obstructive uropathy?

Structural/functional abnormality that obstructs normal urine flow

What is hydronephrosis?

Dilation of the renal pelvis from backed-up urine

What happens when urine flow is obstructed?

Urine backs up → renal pelvis dilates → hydronephrosis

How is obstructive uropathy treated?

Surgical removal or bypass of obstruction