Question | Answer |
The single most important host factor influencing the occurrence of UTI is | urinary stasis |
Clinical manifestations of UTI in neonate(birth to 1 month) | poor feeding, V, incr resp(acidosis), frequent urination, screaming on urination, jaundice, seizures, dehydration |
Clinical manifestations of UTI in infant | excessive thirst, foul-smelling urine, pallor, fever, persistent diaper rash |
Clinical manifestations of UTI in childhood | growth failure, enuresis, incontinence, swlling of face, fatigue, blood in urine, abd/back pain, edema, htn, tetany |
Infants and young child may show no s/s of UTI except fever, V, decr appetitie/activity, fatigue, but with infant what do you want to rule out? | UTI, pneumonia and meningitis |
what is normal newborn urine production amt?
child? | Inf: approx 1-2ml/kg/h
child: 1ml/kg/h |
Define UTI | irritation of the lining of the bladder, urethra, ureters, and kidneys |
an upper tract involves?
lower? | upper: renal parenchyma, pelvis, ureters and cause fever, chills, flank pain
low: bladder and urethra causes no s/s |
vesicoureteral reflux refers to what? More likely associated with recurring what infections? | abnormal regtrograde flow of bladder urine into ureters.
Kidney infections(pyelonephritis) rather than bladder infections |
What is difference in complicated and uncomplicated UTI | comp: stones, obstruction, catheters, DM, recurrent inf
uncomp: occurs in otherwise normal urinary tract |
4 types of UTIs | recurrent
persisten
febrile: indicates pyelonephritis
urosepsis: uremia(urine in blood), bacterial |
If young child/inf come in with fever, what is standard with each assessment | Urine sample from suprapubic aspiration of urine or sterile catheterization |
Ways to avoid UTI | hygiene: front to back wiping
cotton panties
check for pinworms/vaginitis
avoid holding
empty bladder
avoid straining during defecation
encourage fluid intake |
What is a hydrocele?
tx? | fluid in scrotum
tx: surgical repair |
inguinal hernia?
tx? | protrusion of abd contents into scrotum
tx: surgical |
phimosis?
tx? | narrowing/stenosis of preputial opening of foreskin
tx: retract skin/circumcision |
hypospadias?
tx? | urethral opening located behind glans penis or anywhere along ventral surface of penile shaft
tx: sugery |
Chordee?
tx? | ventral curvature of penis from hypospadias
tx: surgical release of fibrous band |
epispadias?
tx? | meatal opening located on dorsal surface of penis
tx: surgical |
cryptorchidism?
tx? | testes fail to descend
tx: surgical, GH for older child |
exstrophy of bladder?
tx? | eversion of bladder thru ant bladder wall, severe defect |
ambiguous genitalia? | masculinized female
incomplete male
true hermaphrodite
mixed |
A urine dipstick ids presence of | nitrites, WBCs, leukocyte esterase |
What is preferred dx study to obtain urine? | clean catch |
IVP or Abd Ct is good for spotting what | suspected obstruction and reflux |
Antibiotics for UTI?
pain relievers? | bactrim(TMP-SMX), amoxicillin, cephalexin
pyridium:numbs nerves, turns pee orange
urised: turns pee blue |
describe nephrotic syndrome | massive proteinuria, hypoalbuminemia, hyperlipidemia, edema |
hypovolemia can occur as the fluid moves out of the vascular stimulates what system | renin-angiotensin system and secretion of ADH and aldosteroneq |
Nephrotic syndrome is manifested with these s/s in a child | wt gain, tight fitting clothes, decr urine output, pallor, fatigue, puffy face, ascites, swelling |
most common type of nephrotic is?
other two types? | MCNS: Minimal change nephrotic syndrome
congenitaland secondary |
Nephrotic syndrome tx?
Nsg intv? | steroids to decr immune reaction(2mg BID of Prednisone)
Cytoxan(immunosuppressant therapy)
diuretics: to compensate
abx
Nsg: avoid incontinent episodes, hydrate(dilutes, flushes), follow up UA |
Nephrotic syndrome diet | low to mod protein
Na restriction with lg edema
no K restriction |
Define Acute Glomerulonephritis | type of kidney disease with inflammed glomeruli and impair kidney's ability to filter urine. |
Acute glomerulonephritis usually stems from | strep infection, but can also be pneumoccocal or viral.
poststreptococcal: one wk after inf as a reaction from antibody from having strep |
s/s of acute glomerulonephritis | oliguria, edema(periorbital and spreads to abd and extremities), htn, hematuria(tea colored), proteinuria |
severe glomerulonephritis can raise what electrolyte | potassium |
In children what usually causes acute kidney failure? | dehydration |
Most frequent cause of acute kidney failure from 6mos-5y, in the summer? | hemolytic-uremic syndrome |
what is causative agent?
s/s? | ecoli from contaminated food or water in swimming
s/s: abd pain, bloody/watery D, V, oliguria/anuria, petechiae, HTN, seizures, coma |
In hemolytic-uremic syndrome, the arterioles are clogged how? | toxins destroy RBCs, so low filtration to cause kidney failure. Also spleen destroys RBCs so anemia is common |
In dx of hemolytic-uremic syndrome, what is the triad to be seen?
What lab levels will be elevated? | anemia, thrombocytopenia, renal failure
BUN & creatinine with a low H&H |
Best tx for hemolytic-uremic syndrome? | tx: hemodialysis/peritoneal |
Describe ARF(acute renal failure), CRF(chronic), ESRD(end stage renal disease) | acute: kidney suddenly stops filtering waste from blood
chronic: dev slowly w/ few s/s
esrd: failure |
What is principle feature of ARF?
what is azotemia?
Most transcient cause? | oliguria, azotemia, metabolic acidosis, electrolyte disturbance
azo: waste build up of nitrogenous waste in blood
cause: severe dehydration |
What is best test to determine chronic renal failure? | creatinine level test adn is often first sign of kidney failure occurring even before pt feels sick. |
what is most immediate threat of ARF in child? | hyperkalemia, restrict K from food or give Kaexylate, peritoneal dialysis/hemo |
With chronic renal failure, diet is best way to reduce quantity of materials that need to be excreted, what is goal? | sufficient in calories/protein while not over taxing kidney excretory demans, minimize metabolic bone disease, minimize electrolyte/fluid disturbs |
When evidence of edema and HTN waht is restricted from diet as well | h2o and na and phosphorus, not K and metabolic acidosis is alleviated with Na bicarb |
what is preferred dialysis for children? | peritoneal dialysis |
What are concerns in transplantation as far as complication? hurdle? avoid what meds? | encephalopathy is big issue and if adult kidney used, then size can be hurdle in newborn, no aluminum containing meds |
what happens in proximal tubule?
loop of henle?
distal?
collecting ducts? | prox: reabsorb Na majority
Loop: concentrate urine, water reabsorption(desc), Na reabsorbed(ascend)
distal: secrete K,urea,H,ammonia
coll: reabsorb h2o(adh req.), final concentration |