↑↓ renal

UTI:

lower: urethra and bladder (urethritis/cystitis)

upper: ureters, renal pelvis, calyces, and renal parenchyma

dx. urine dipstick — presence of leukocytes, esterase and nitrites, bacteria and WBC

• Culture and sensitivity-clean catch or catheterization

• Bacteria colony count is >50,000/ml

trx. antibiotics (Trimethoprim-sulfamethoxazole (TMP-SMX)…)

• analgesics/antipyretics

prevention: Perineal hygiene—wipe from front to back.

• Avoid tight clothing or diapers;

• wear cotton Underwear rather than nylon.

• Avoid “holding” urine stasis

• Encourage generous fluid intake

• Prevent constipation

• urinate after intercourse

vesicoureteral reflux (VUR): urine backflows from bladder → upper urinary tract

Primary reflux: congenital anomaly that affects the ureterovesical junction.

Secondary reflux: anatomic or functional bladder obstruction → abnormally high pressure in the bladder

•Renal scarring predisposes to kidney disease

s/s. UTI s/s

dx. culture

voiding cystourethrography

contrast injected into bladder until full and takes pictures before, during, and after to visualize bladder outline and urethra revealing reflux of urine into ureters and abnormalities of bladder emptying

trx. Continuous antibiotic prophylaxis (CAP)

• Surgery or Endoscopy

  • Breakthrough febrile UTIs despite antibiotic prophylaxis

  • Severe reflux

  • Mild or mod reflux in females persists puberty

  • Poor compliance with medications or surveillance

  • Poor renal function or appearance of new scars

• Screen siblings-Renal ultrasound

Acute Glomerulonephritis (AGN): Immune complex formation and glomerular deposition → ↓ GFR → ↑ retention of water / Na → edema / HTN

Types:

1. Post Infection (Pneumococcal, streptococcal, or viral)

2. Primary

3. Systemic Disorder Manifestation (SLE, SCD, Bacterial endocarditis)

s/s: Low C3 complement levels

• Periorbital, lower extremity edema

• Loss of appetite

• ↓ u/o -oliguria

• Cola colored urine

trx. Bed rest acute phase

• B/P every 4 to 6 hours; Seizure precautions

Diet: Na and h2o restrictions, Potassium and protein restricted with oliguria

• Antibiotic therapy-strep positive

•1st sign of improvement= increased urine output

•Decrease in body weight (edema decreases)

•BP returns to normal

•Hematuria and proteinuria may persist for months to years

•Renal function typically returns to normal by 8 wks

chronic glomerulonephritis: Tissue damage and progression to fibrosis → change glomerular structure → end-stage renal disease (ESRD)

dx. ↑ BUN, creatinine, and uric acid levels

s/s. Hypertension, edema, intermittent gross hematuria

• Metabolic acidosis, ↑ potassium, and ↓ calcium levels

trx. Prolonged course

• Corticosteroids or cytotoxic agents, Antihypertensive, erythropoietin and iron

• Dialysis/Transplant for end stage

Nephrotic syndrome Glomerular injury → permeability to plasma protein → Massive urinary protein loss/Edema

3 Types:

1. Minimal Change Nephrotic Syndrome (MCNS)- Most common primary

2. Secondary Nephrotic Syndrome (SNS)

• where the disease is caused by systemic conditions such as AGN & CGN most common

3. Congenital Nephrotic Syndrome-Finnish Type (CNS)

•Autosomal recessive disorder manifesting w/in 1^st months of life → Death before 3 yrs w/o treatment

s/s. Generalized edema (anasarca)

• Pitting edema, Weight gain, Ascites, abdominal pain

• Pallor, fatigue,

• Decreased u/o

tx. Diet: ↓ protein, ↓ Sodium,

Prednisone: 2 mg/kg divided into BID doses

• u/o will start to increase within  7 to 21 days of therapy

Immunosuppressant therapy (Cytoxan)

Diuretics

nursing consideration:

• I&O’s, Daily weights

• Ascites: Measurement of abd girth

• Nutritional education

• Medication compliance

• Psycho-social considerations

Acute renal failure: Not common in children

severe dehydration → Kidneys suddenly unable to regulate the volume and composition of urine

s/s. Severe oliguria (urinary output of less than 1 ml/kg/hr) followed by abrupt onset of diuresis-output phase

• azotemia,

• Tachypnea →metabolic acidosis

• electrolyte disturbances (Hyponatremia or hypocalcemia) → Seizures

• Hypervolemia, Cardiac failure with pulmonary edema

chronic kidney disease: Long-term, progressive loss of kidney function
→ Retention of Waste Products, Water and Sodium, potassium → Acidosis-Respiratory distress, Growth Disturbance

→ Susceptible to infection, especially pneumonia, UTI, and septicemia

→ Hypertension and cardiac failure

peritoneal dialysis

filtration from peritoneal cavity by gravity (Semipermeable membrane)

• managed at home

Hemodialysis (best for children)

rapid correction of fluid and electrolyte abnormalities via vascular access

3 times per week for 4 to 6 hours (home or facility)

transplant:

• living, related donor, OR cadaver donor

•Primary goal is long-term survival of grafted tissue

•Rejection-Role of immunosuppressant therapy

•Good prognosis, may need 2^nd or 3^rd transplant (long term)

•Less negative impact on daily life activities vs. dialysis