8. Genitourinary Disorders (1)

Genitourinary Disorders in Children

Urinary Tract Infections (UTIs)

  • Types: UTIs can affect the upper urinary tract (kidneys) known as pyelonephritis or the lower urinary tract (bladder) known as cystitis.

  • Causes: Most UTIs are caused by bacteria from fecal flora (e.g., Escherichia coli) that ascend through the urinary tract.

  • Paths of Infection:

    • In females, bacteria ascend the short urethra, often facilitated by sexual intercourse.

    • Pyelonephritis occurs when bacteria infect the kidneys via the ureters.

  • Clinical Manifestations of Pyelonephritis:

    • Dysuria

    • Fever

    • Flank pain

    • Costovertebral angle tenderness

    • Nausea and vomiting

    • Increased urinary frequency

  • Complications: May lead to sepsis, acute respiratory distress syndrome, and acute kidney injury.

  • Nursing Interventions:

    • Obtain urine culture to identify causative microorganism.

    • Administer antibiotics.

    • Monitor vital signs for signs of urosepsis.

    • Administer antipyretics for fever.

Pyelonephritis

  • Definition: A bacterial infection of the kidney that requires a urine specimen for culture and sensitivity.

  • Monitoring: Keep track of vital signs to identify signs of urosepsis or septic shock, particularly changes in blood pressure and respiratory rate.

Acute Glomerulonephritis (AGN)

  • Description: An inflammatory reaction in the kidneys causing protein leakage into the urine.

  • Symptoms: Results in hypoalbuminemia, leading to fluid leakage into interstitial spaces, causing hypertension and edema.

  • Plan of Care: Include daily weight measurements, the most accurate indicator of fluid volume status in acutely ill clients. Daily weights should be assessed consistently.

  • Cause: Often follows a recent streptococcal skin or throat infection, causing antibody complexes to lodge in glomeruli and trigger inflammation.

Clinical Features of AGN

  • Symptoms:

    • May be asymptomatic.

    • If symptomatic: gross hematuria, edema (periorbital, generalized), hypertension.

  • Laboratory Findings:

    • Urinalysis showing protein, blood, RBC casts.

    • Serum findings include decreased complement levels, increased serum creatinine, and increased ASO or streptozyme tests.

Complications of AGN

  • Hypertension: Severe hypertension may develop suddenly and should be identified early to prevent progression of kidney injury.

  • Damage Monitoring: Control hypertension to prevent hypertensive encephalopathy and pulmonary edema.

Acute Poststreptococcal Glomerulonephritis (APGN)

  • Overview: An immune reaction following infection, typically streptococcal.

  • Clinical Features:

    • Can be asymptomatic or present with gross hematuria, edema, and hypertension.

    • Laboratory findings: protein in urine, decreased serum complement levels, increased serum creatinine.

  • Complications: At risk for acute kidney injury (AKI), cerebral edema, and pulmonary edema.

  • Management: Supportive care including fluid and salt restrictions, and diuretics. Daily weights to guide treatment.

Management for APGN

  • Supportive Measures:

    • Monitor and restrict fluid intake.

    • Utilize IV loop diuretics to manage edema and potassium levels.

    • Limit physical contact to minimize infection risks during relapses.

Nephrotic Syndrome

  • Definition: A collection of signs caused by glomerular injury characterized by proteinuria, hypoalbuminemia, edema, and hyperlipidemia.

  • Symptoms:

    • Massive proteinuria

    • Hypoalbuminemia leading to edema, especially in the face, abdomen, and limbs.

    • Hyperlipidemia due to compensatory liver lipid production.

  • Most Common Cause: Minimal change nephrotic syndrome, generally idiopathic.

    • Secondary causes include systemic diseases, infections, and drug toxicity.

  • Clinical Manifestations:

    • Increased permeability to proteins, resulting in generalized edema and low urine output.

    • Elevated susceptibility to infections due to the loss of immunoglobulin.

Vesicoureteral Reflux (VUR)

  • Definition: Abnormal retrograde flow of urine from the bladder into ureters and kidneys.

  • Causes: Congenital conditions, posterior urethral valves, neurogenic bladder.

  • Management: Encourage frequent voiding, monitor for UTIs, and may require surgical intervention in persistent cases.

Wilms Tumor (Nephroblastoma)

  • Description: A kidney tumor primarily affecting children under age 5, mainly occurring in one kidney.

  • Signs: Diagnosed upon observation of abdominal swelling; avoid palpation of the abdomen prior to definitive diagnosis.

Circumcision Care

  • Overview: Removal of the foreskin; care includes hygiene practices and recognition of normal healing signs (e.g., yellow exudate).

  • Signs of Infection: Increased redness, odor, or abnormal discharge should be reported.