pediatric renal disorders

🧾 What is Acute Glomerulonephritis (AGN)?

• A kidney problem that happens in kids after strep throat or skin infection 🦠

• Most common type: Acute Post-Streptococcal Glomerulonephritis (APSGN)

  • APSGN is an immune disease that occurs after a Group A beta-hemolytic streptococcal infection

 

🧑‍⚕ Why Does It Happen?

• Body makes antibodies (soldiers) 🛡 to fight strep bacteria

• These antibodies clump together ⚔ → called immune complexes

• Complexes get stuck in the kidney filters (glomeruli 🧽)

• This causes swelling 💧 and clogging 🚫

 

🏗 What Happens in the Kidneys?

• Filters can’t clean blood properly ❌🩸

• Water + salt stay in body → swelling in face, belly, legs 🧑‍🍼👣

• Blood pressure goes up ⬆💢

• Pee looks dark/tea-colored/bloody ☕🩸

 

📅 When Does It Show Up?

• 1–3 weeks (8–21 days) after a strep infection ⏳🤒

Acute Glomerulonephritis (AGN) Symptoms

• Swollen face in the morning 😲

• Swollen belly or legs 🦵

• Less pee 🚽

• Dark/cola-colored pee 🥤

• Headache from high blood pressure 🤯

• Feeling tired 🛌

 

🩺 Key Point

• It’s not the strep germs hurting the kidneys anymore — it’s the immune system reaction 💥🧽

Acute Glomerulonephritis (AGN) 🧩 Contributing Factors

• Recent streptococcal, pneumococcal, or viral infection 🤒

• Most common in summer or early fall ☀🍂

• Family history of kidney problems 👨‍👩‍👧

Acute Glomerulonephritis (AGN) 🔍 Expected Findings

• Severely decreased urine output 🚽⬇

• Edema/Weight gain 💧⚖

• Anorexia (poor appetite) 🍽❌

• Smoky-brown / tea- or cola-colored urine ☕🥤

  • Proteinuria + Hematuria 🧪🩸

  • Decreased GFR ⬇

• Headache, dysuria, abdominal pain 🤕😣

• Lethargy, irritability, pallor 🛌😠😶

• Azotemia (waste buildup in blood) 🧫

• Increased blood pressure ⬆💢

Acute Glomerulonephritis (AGN) 🧪 Laboratory Tests / Diagnostic Procedures

• Urinalysis (UA) 🧴 → look for cola-colored urine, low output

• BUN & Creatinine 🔬

• BMP 🧪 → electrolytes, glucose, bicarbonate

• GFR (Glomerular Filtration Rate) 🧮

• Antistreptolysin O Titer (ASO) 🦠 → recent strep infection

• Serum Complement (C3 level) 🧫

• Electrolyte panel ⚡

• Chest X-ray 🫁 → check for fluid overload in lungs

 

Acute Glomerulonephritis (AGN) 💊 Therapeutic Procedures & Medications

• Sodium & fluid restriction 🚫💧 (to prevent more swelling)

• Diuretics (Furosemide/Lasix) 💊💦 (help get rid of extra fluid)

• Antihypertensives ⬇💢 (e.g., ACE inhibitors) to control high blood pressure

🧾 Acute Glomerulonephritis (AGN) 🩺 Nursing Interventions

• Activity as tolerated 🏃‍♂➡🛌 (allow rest periods)

• Low sodium diet 🧂❌

  • If oliguric (very little urine) 🚽⬇ → limit potassium ⚡ (to prevent heart arrhythmias ❤⚡)

  • Fluid restriction 💧❌ (be specific: PO + IV)

  • Often on 2 g sodium diet 🧂

• Daily weights ⚖

  • Void before weighing 🚽

  • Same time each day ⏰

• Monitor level of consciousness (LOC) 🧠 (watch for confusion or behavior changes)

• Vital signs (especially BP) 💢

• Monitor intake & output (I&O) 📝

• Monitor skin 🩹 (for breakdown from edema)

• Measure abdominal girth 📏 (track swelling/ascites)

• Referrals (nutritionist, nephrologist, etc.) 🧑‍⚕

• Watch for complication: Hypertensive Encephalopathy ⚡🧠

  • Signs: sudden headache, N/V, seizures, confusion, vision changes 👀

  • First action: Check BP before calling provider 🚨📈

🧾 Acute Glomerulonephritis (AGN) 📚 Client Education

• Dietary restrictions 🧂❌💧 (low sodium, fluid limit, potassium if needed)

• Fluid restriction 💧➡ exact amount (teach family/patient how to track)

• Follow-up appointments 📅

• Infection prevention 🧴 (hand hygiene, avoid sick contacts, since they are immunocompromised)

• Rest periods 🛌 (don’t overexert—frequent breaks during activity)

🧾 Nephrotic Syndrome (MCNS) 🧩 Contributing Factors

• Age: Primarily in preschoolers (3-6 years old) 👶👦

• Gender: Male > Female (2:1 ratio) 👦 > 👧

• Often preceded by viral URI 🤧

• Cause often unknown ❓

• Can result from one of four renal lesions (MCNS most common)

• Possible triggers: metabolic, biochemical, immune-mediated disturbance ⚡

• Pathogenesis not fully understood

🧾 Nephrotic Syndrome (MCNS) 🔍 Expected Findings

• Edema/Ascites 💧 (may start around eyes in AM, spread during day)

• Anasarca (generalized body swelling – gradual or rapid) 🧍‍♂⬆

• Normal BP ✔💢

• GI issues: anorexia, diarrhea 🍽❌💩

• Urine changes: dark, frothy, ↓ UOP 🚽⬇☁

• Other symptoms:

  • Pallor 😶

  • Fatigue / irritability 🛌😠

  • Muehrcke’s lines (white nail lines) 💅⚪

  • Susceptible to infection 🦠

• Labs / body changes:

  • Hypoalbuminemia ⬇🧪 (low albumin in blood)

  • Massive proteinuria 🧪➡ urine frothy ☁

  • High urine specific gravity + hyaline casts 🧫

  • Hypercholesterolemia ⬆🥓

  • ↑ Platelets 🩸

  • Hyponatremia ⬇🧂

  • Hypocalcemia ⬇🦴

🧾 Nephrotic Syndrome (MCNS) 🧪 Laboratory Tests / Diagnostics

• Serum albumin & serum protein ⬇🧪

• BMP (BUN, Creatinine, Electrolytes) 🧫

• CBC 🩸

• UA (Protein:Creatinine ratio) 🧴

• Urine specific gravity ⚖

• Renal biopsy (to confirm diagnosis) 🔬

🧾 Nephrotic Syndrome (MCNS) 💊 Therapeutic Procedures & Medications

• Corticosteroids 💊 (main treatment → reduce swelling, protein loss)

• Diuretics (Furosemide) 💦 (for edema relief)

• Immunosuppressants 💉 (Cyclophosphamide, Cytoxan if no steroid response)

• Albumin infusions 💧 (replace lost protein, pull fluid back into vessels)

• Sodium & fluid restrictions 🧂❌💧❌

• Vaccines 💉 (avoid live vaccines if immunosuppressed)

🧪 Nephrotic Syndrome

👉 It’s not one single disease, but a group of symptoms that happen when the kidney’s filters (glomeruli) are damaged.

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🚰 What Happens

• The filters are supposed to keep protein in the blood 🩸, but when they’re damaged they leak protein into the urine 💧.

• Losing protein causes fluid shifts in the body → swelling (edema).

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🩺 Classic 4 Signs (the “nephrotic tetrad”)

1. Massive protein in urine (proteinuria) 💧

2. Low blood protein (albumin) 📉

3. Swelling (edema) 😵 (face, belly, legs)

4. High cholesterol & triglycerides 🧈

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👶 Who Gets It?

• Kids: Minimal Change Disease (MCNS) is the most common cause.

🧾 Nephrotic Syndrome (MCNS) 📚 Client Education

• Teach families how to check urine for protein 🧪 (dipsticks at home)

• Diet teaching 🥗: foods allowed, sodium/fluid restrictions

• Medication teaching 💊: purpose, administration, side effects (esp. corticosteroids & immunosuppressants)

• Reassure parents 🤝: symptoms improve with treatment; recovery expected in many children

• Address social isolation & boredom 🎲📚 (rest periods can limit activity → encourage safe play & support)

• Explain relapse patterns 📅:

  • Steroid-responsive kids → fewer relapses, longer time between relapses

  • Steroid-resistant kids → harder to treat, more complications

🧾 Nephrotic Syndrome (MCNS)🩺 Nursing Interventions

• Encourage quiet activity & rest 🛌 (minimize stress & fatigue)

• Strict I&O monitoring 🧴 (track urine; monitor protein/creatinine ratio)

• Daily weights ⚖ (same time, same scale; void before weighing 🚽)

• Measure abdominal girth 📏 (track ascites/edema)

• Monitor skin integrity & vital signs 🩹💓

• Prevent infection 🚫🦠 (avoid sick contacts)

• Skin care for edema: elevate swollen parts 🦵, keep clean, separate with clothing/cotton, use antiseptic powder 🧴

• Dietary management 🥗

  • Low sodium diet

  • Fluid restriction (individualized based on swelling & urine output)

  • Dietary consult for guidance

• After edema subsides 💧➡✔ resume normal activities gradually

🧬 Hemolytic Uremic Syndrome (HUS)

📌 What is it?

• Acute Renal Disease 🫘

• ARF (Acute Renal Failure) 🚨

• Happens when E. coli (from undercooked meat 🥩) or other causes release toxins → these destroy red blood cells (hemolytic anemia) ❤.

• Broken RBCs + toxins clog kidneys → kidney failure.

• Blood doesn’t clot well because of low platelets (thrombocytopenia).

 

📊 Risks / Types

• Diarrhea Positive (D+ HUS): 💩 Seen in ~90% of cases, usually after E. coli infection.

• Diarrhea Negative (D- HUS): ⚠ Can be from non-intestinal infections, problems in the complement system, malignancies, or genetic disorders.

 

👶 Who Gets It?

• Peak ages: 6 months – 4 years old.

🧬 Hemolytic Uremic Syndrome (HUS) 🧾 Triggers / Causes

• After diarrhea & vomiting (prodromal period).

• Sometimes after infections like MMR, Varicella, or UTI.

🧬 Hemolytic Uremic Syndrome (HUS) 👀 Expected Findings

• Irritability 😠

• Lethargy 😴

• Stupor 😵‍💫 (a state of near-unconsciousness or insensibility)

• Loss of appetite 🤢

• Hallucinations 🌀

• Edema (swelling) 💧

• Pallor (pale) 😶

• Purpura, ecchymosis (purple bruises) 🟣

• Rectal bleeding 💩🔴

• Anuria (no pee) 🚱 or oliguria (very little pee)

• Hypertension (high BP) 📈

🧬 Hemolytic Uremic Syndrome (HUS) 🧪 Laboratory Tests & Diagnostics

• CBC (Complete Blood Count) → checks for anemia + low platelets.

• Urine tests → kidney function.

• BMP (BUN/Creatinine & electrolytes) → kidney function.

• Fibrin split products in blood/urine → confirms thrombocytopenia.

🧬 Hemolytic Uremic Syndrome (HUS) 🏥 Therapeutic Procedures & Medications

• Hemodialysis (HD) 🩸

• Peritoneal Dialysis (PD) 🫘

• Continuous hemofiltration

• Plasma infusion (still under study)

• ⚠ No evidence that heparin, corticosteroids, or fibrinolytic agents are helpful.

🧬 Hemolytic Uremic Syndrome (HUS) 🍎 Nutrition

• Enteral nutrition (through the gut) after diarrhea & vomiting resolve.

• Parenteral nutrition (through the vein) if persistent colitis & tissue breakdown.

• C/S diet (dietary consult to guide care).

🧬 Hemolytic Uremic Syndrome (HUS) 🩺 Nursing Interventions

• Monitor Intake & Output (I/O) 🚰

• Daily weights ⚖

• Careful with fluid replacement if child is edematous 💧

• Treat hypertension 💊

• Correct electrolyte imbalances & acidosis ⚡

• Monitor CNS status 🧠 (seizures, stupor)

• Seizure precautions 🛏

• Blood transfusions cautiously for severe anemia 💉

Hemolytic Uremic Syndrome (HUS) 📚 Client Education

• Teach family to avoid undercooked meat 🥩

• Avoid unpasteurized apple juice 🍏🥤

• Avoid unwashed raw veggies 🥗

• Avoid alfalfa sprouts 🌱

• Avoid public pools 🏊

• 🚫 Do NOT use anti-motility meds for diarrhea

• Rehydrate kids after diarrhea & vomiting 💧

• Provide emotional support to child & family ❤

💧 Peritoneal Dialysis (PD)

📌 What is it?

• A type of dialysis where a special fluid is put into the belly (peritoneal cavity) through a catheter.

• The fluid absorbs waste and extra fluid from the blood, then is drained out.

• Preferred in many children because it’s gentler and safer than Hemodialysis.

 

✅ Benefits

• Safer → less risk of sudden blood pressure drops.

• Can often be done at home.

• No need for vascular access (so no fistula, thrill, or bruit).

 

⚠ Risks

• Peritonitis (infection in the belly) → look for fever, abdominal pain, cloudy drainage fluid.

• Catheter site infection 🚨.

🧾 Wilms Tumor (Nephroblastoma)

• The most common childhood cancer of the kidney 🧽🎗

• Happens mostly in kids under 5 years old (75%) 👶👧

• About 5% run in families 👨‍👩‍👧‍👦

🔍 Expected Findings

• Painless abdominal mass 😮 that does not cross the midline 🚫↔

• Weight loss ⚖⬇

• Hepatomegaly & splenomegaly (big liver + spleen) 🍎

• Anemia 🩸⬇

⚠ VERY IMPORTANT

• Never palpate (press on) the abdomen 🚫🤲 → tumor could rupture 💥

💊 Treatment

• Surgery 🔪

• Chemotherapy 💉

• The higher the stage, the worse it is (Stage 4 = both kidneys involved) ⚠🧽🧽

🧾 Urinary Tract Infections (UTIs)

🧩 What is it?

• A UTI is an infection in the urinary tract 🚽🦠.

  • Lower tract: urethra + bladder

  • Upper tract: ureters + kidneys 🧽

 

👩‍⚕ Who gets them?

• Adolescents with UTIs are more concerning ⚠ → they can get very sick and go into sepsis (blood infection) 💉🦠.

• Recurrent UTIs (keep coming back) → doctors repeat a urine culture 7 days after treatment 🧫.

🧾 Urinary Tract Infections (UTIs) ⚠ Complications

• Progressive kidney injury 🧽⬇

• Pyelonephritis (kidney infection) 🔥🧽

• Neuropsychiatric complications (brain/behavior problems if infection spreads) 🧠⚠

🧾 Urinary Tract Infections (UTIs) 🧩 Contributing Factors (Risks)

• Female 👧

• Caucasian

• Uncircumcised male 👦

• Vesicoureteral reflux (VUR) 🔄 (urine goes backward)

• Sexual activity, masturbation 🙈

• Incomplete bladder emptying 🚽

• Low fluid intake 💧⬇

• Urinary tract abnormalities 🧬

• Constipation 🚫💩

• Tight clothes 👖

• Catheters 🧴

• Pinworms 🪱

• Bubble baths, hot tubs 🛁

• Start of toilet training 🚽👶

🧾 Urinary Tract Infections (UTIs) 🔍 Expected Findings

Infants 👶

• Irritable 😡

• Diaper rash 👶🩹

• Fever or hypothermia 🌡

• Screaming with urination 😭🚽

• Lethargy 🛌

• Poor feeding 🍽❌

• Vomiting/diarrhea 🤮💩

• Jaundice, cyanosis, hematuria 🟡🔵🩸

Children 👧👦

• Abdominal or back pain 🤕

• Dysuria (pain peeing) 🚽🔥

• Cloudy urine with mucus ☁

• Hematuria (blood in urine) 🩸

• Incontinence (wetting after toilet trained) 🚽💦

• Enuresis (bedwetting) 🛏💧

• Boys: dribbling urine, straining 💦😣

• High fever 🌡⬆

• Flank/abdominal pain 🤕

• Pyelonephritis signs: high fever + leukocytosis 🦠🩸

🧾 Urinary Tract Infections (UTIs) 🧪 Laboratory Tests / Diagnostics

• UA (urinalysis) 🧴

• Urine culture 🧫 (clean catch or catheter for infants/toddlers)

• Ureteral catheterization 🧪

• Bladder washout 🚿

• Renography 🧬

• Ultrasound 💻

• Voiding cystourethrogram (VCUG) 🔄

• IV pyelography 💉💻

• DMSA scan (Dimercaptosuccinic acid scan) 🧪

🧾 Urinary Tract Infections (UTIs) 💊 Treatment

• Antibiotics 💊

  • IV antibiotics for pyelonephritis

• Analgesics 💊 (pain relief)

• Fix anatomical problems 🧬 if present

🧾 Urinary Tract Infections (UTIs) 🩺 Nursing Interventions

• Proper collection of clean-catch specimens 🧴

• Try to collect first morning void 🌅 (more concentrated sample)

• Assist with suprapubic aspiration or catheterized specimen for culture 💉

• Encourage adequate fluid intake 💧

• Monitor urine output (UOP) 🚽

• Administer mild analgesia 💊 (pain relief for dysuria)

• Encourage a high-fiber diet 🥦 (prevents constipation, which can worsen UTIs)

🧾 Urinary Tract Infections (UTIs) 📚 Client Education

• Females: Wipe front-to-back 🚺🧻

• Teach “double voiding” (pee, wait, then pee again) 🚽🔁

• Uncircumcised males: Teach how to retract & clean foreskin 👦🧼

• Change out of wet clothing quickly 👕💦

• Avoid bubble baths, whirlpools, hot tubs 🛁❌

• Void immediately after intercourse 🚻⚡

• Complete the antibiotic regimen 💊✔ (take all meds, even if feeling better)

Defects of the Genitourinary Tract

🧩 What are they?

• Structural disorders 🧬 can be present at birth 👶.

• These affect the genitals, urinary system, and sometimes reproductive function 🚻.

• Examples: hypospadias, epispadias, cryptorchidism, ambiguous genitalia (each changes how the urinary or reproductive tract develops).

 

👦👧 Child Development Note

• Children become aware of genitals and sex differences between ages 3–6 🧒➡👦👧.

• Because of this, repairs are best done early:

  • Between 6–12 months of age ⏰

  • Before age 3 🧸

• This helps protect body image 🪞 and supports healthy growth and development 🌱.

 

⚠ Risks

• Can be genetic 🧬 (runs in families).

• May be linked with other birth defects or syndromes.

🧾 Defects of the Genitourinary Tract  Chordee

• What it is: Ventral (downward) curvature of the penis ↘🍌

• Treatment: Surgical release of the fibrous band ✂

🧾 Defects of the Genitourinary Tract 🔹 Bladder Exstrophy

• What it is: The posterior bladder wall everts (turns out) through the anterior abdominal wall → bladder is exposed outside the body 🚨🧽

• Findings:

  • Exposed bladder, urethra, ureteral openings in the suprapubic area

  • Often associated with epispadias

• Nursing:

  • Cover exposed bladder with a sterile, nonadherent dressing 🩹

  • Prepare for immediate surgery ⏱🔪

🧾 Defects of the Genitourinary Tract 🔹 Hypospadias

• What it is: The urethral opening is not at the tip but below the glans penis or anywhere along the ventral surface of the penis ⬇🍌

• Can extend to the scrotum or perineum

• Sometimes chordee (curved penis) is also present

• Treatment: Surgical repair, usually before toilet training 🚽

 

🧾 Defects of the Genitourinary Tract 🔹 Epispadias

• What it is:

  • Male: Urethra opens on the dorsal (top) surface of penis ⬆🍌; widened pubic symphysis; possible bladder exstrophy

  • Female: Wide urethra, bifid (split) clitoris, possible bladder exstrophy

• Treatment: Surgery within the first year of life ⏱👶🔪

 

🧾 Defects of the Genitourinary Tract 🔹 Phimosis

• What it is: Narrowing of foreskin opening → foreskin can’t be retracted over glans penis 🚫⬆👦

• Normal in infants and young boys → usually resolves with age ✅

• Nursing care:

  • Good hygiene: external cleansing only 🧼

  • Do NOT forcibly retract foreskin ❌✋

Defects of the Genitourinary Tract 🔹 Testicular Torsion

• What it is: Testicle twists on its blood supply 🔄⚽

• Finding:

  • Extreme pain 😱 (sudden or gradual)

  • Pain radiates to groin 🚨

• Treatment: Immediate surgery ⏱🔪 (emergency → saves the testicle!)

Defects of the Genitourinary Tract  🔹 Cryptorchidism

• What it is: Undescended testes (not in the scrotum) ❌⚽

• Finding: Can’t feel the testicle in the scrotum 👀

• Treatment: Surgical orchiopexy ⚕ usually done between 6–24 months of age

Defects of the Genitourinary Tract  🔹 Hydrocele

• What it is: Fluid in the scrotum 💧⚽

• Finding: Enlarged scrotal sac 😮

• Treatment: Often resolves on its own ✅. If not → surgery after 1 year ⏱🔪

 

Defects of the Genitourinary Tract  🔹 Varicocele

• What it is: Enlarged, twisted veins in the spermatic cord 🪢

• Finding: Feels like a “bag of worms” 🪱 above the testicle, may cause discomfort during sexual stimulation

• Treatment: Varicocelectomy (surgery to remove/repair veins) 🔪

Defects of the Genitourinary Tract  🔹 Ambiguous Genitalia

• What it is: Abnormal or unclear sexual differentiation ❓🚻

• Tests: Karyotyping 🧬 (chromosome analysis)

• Management: Genetic counseling 👨‍👩‍👦

🧾 GU Surgery Care – Nursing Actions 🩺 Preoperative Nursing Actions

• Education 🧾 (explain procedure in simple terms)

• Emotional support 💙 (reassure family & child)

• Encourage parents to express concerns/fears 🗣😟

• If NPO 🚫🍽 → explain fasting & why it’s important

 

GU Surgery Care – 🩺 Postoperative Nursing Actions

• Assess pain 🩹😣

• Give pain medications 💊

• Administer anticholinergics 💊➡ reduce bladder spasms

• Monitor intake & output (I/O) 🚽

• Wound/dressing care 🩹 (keep site clean & dry)

• Bladder exstrophy care → keep area protected, monitor for leaks 💧

• Monitor for infection 🦠 (redness, fever, discharge)

GU Surgery Care – 📚 Client Education

• Teach ways to prevent infection 🧼 (hand hygiene, wound care)

• No tub baths 🛁❌ for at least 1 week (or as prescribed) → only showers/sponge baths

• Limit activity 🚫🏃 as prescribed → avoid stress on surgical site

GU Surgery Care – ⚠ Complications

• Infection 🦠

• Emotional distress 😢 (body image, self-esteem concerns for child/family)