Ch17_Renal in children

Chapter 17: Renal Disorders

Introduction

  • Anatomy and physiology of the renal system.

  • Nursing assessment of possible renal disorders in pediatric patients:

    • General history

    • Family history

    • Dietary history

    • Physical examination

Enuresis

  • Definition: Uncontrollable urination after expected age of bladder control.

  • Emotional issues: Low self-esteem, feelings of isolation, fears.

  • Supportive approaches:

    • Listen to children's concerns.

    • Involve children in teaching and care planning.

    • Explain regression in hospitalized children as a normal occurrence.

Urine Output

  • Normal urine output:

    • Children: 2 mL/kg/hr.

    • Adolescents: 0.5 to 1.0 mL/kg/hr.

Disorders of the Renal System

Urinary Tract Infections (UTIs)

  • Common pathogen: E. coli.

  • Congenital anomalies and pathological findings:

    • Most frequent with UTIs.

    • Vesicoureteral reflux (VUR): Most cases resolve with time; some may require surgery.

Prevention of UTIs

  • Education on prevention and treatment:

    • Watch for symptoms: dysuria, frequency, urgency.

    • Hygiene practices:

      • Females: Wipe front to back.

      • Uncircumcised males: clean and replace foreskin properly.

    • Change infant diapers frequently.

    • Use cotton and dry underwear.

    • Avoid bubble baths.

    • Encourage frequent voiding.

Nephrolithiasis (Renal Calculi)

  • Clinical presentation includes:

    • Abdominal/flank pain, hematuria, poor feeding, N/V.

  • Diagnostic measures:

    • Urinalysis: Hematuria or casts are present.

    • Ultrasound findings of calculi.

  • Nursing care:

    • Ensure adequate fluid intake, administer IV fluids, manage pain, strain urine for stone collection.

Acute Glomerulonephritis (APSGN)

  • Most common form is post-streptococcal.

  • Common in children aged 5-8 years, typically 14 days post-infection.

  • Expected findings:

    • Cloudy, tea-colored urine, edema, decreased urine output, irritability, poor appetite, low-grade fever, vomiting.

  • Notable symptoms: periorbital edema, hypertension.

  • Monitoring and care includes:

    • Check blood pressure and fluid status.

    • Dietary sodium and fluid restrictions.

    • Educate on strep throat testing to prevent recurrence.

Nephrotic Syndrome

  • Definition: Excessive protein release into urine due to glomerulus damage.

  • Symptoms:

    • High protein in urine, low serum albumin, severe edema, dark foamy urine, fatigue, abdominal distension, weight gain.

  • Nursing care involves:

    • Monitoring fluid status and possible swelling.

    • Administer diuretics and IV albumin.

    • Using corticosteroids while assessing for infection risks.

    • Dietary adjustments: low sodium, fluids, and fats.

    • Educate on signs of relapse, including daily weights and urine protein checks.

Acute Renal Failure

  • Prerenal causes are the most common.

  • Inability to excrete waste, concentrate urine, and conserve electrolytes.

  • Expected findings include:

    • Oliguria, edema, drowsiness, cardiac arrhythmias, seizures from electrolyte imbalances.

  • Nursing care:

    • Treat underlying causes, monitor I&O and daily weights, assess for infections.

Chronic Renal Failure

  • Caused by irreversible nephron damage.

  • Most common triggers in children under five: congenital problems, urinary tract malformations, and VUR.

  • Physical assessment findings:

    • Fatigue, pallor, anorexia, weight loss, and delayed growth.

  • Nursing care:

    • Rest, monitor I&O, vital signs, daily weights, promote infection assessment, and encourage adherence to dialysis and medication schedules.

Genitourinary Anomalies

  • Cryptorchidism: Undescended testes; surgery (orchidopexy) performed at 6-24 months to prevent cancer detection issues.

  • Hypospadias: Urethral opening below the glans; surgical repair required at 6-18 months.

Review Question

  • Question: What is the most common cause of acute renal failure in pediatrics?

    • Choices: Ischemia, Massive proteinuria, E. coli, Volume depletion.

  • Correct Answer: Volume depletion is the most common cause of Acute kidney failure in pediatrics.