Exam 12: Peds Genitourinary Disorders
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| Urinary System | chief function is regulation of volume and composition of body fluids and excretion of waste materials.
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| Kidneys (two):What do they do? | Maintain homeostasis.
Produces substances that stimulate RBC formation in bone marrow.
Produce renin, which regulates blood pressure.
(d) Nephron: microscopic functional unit of kidneys.
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| Glomerular filtration and absorption: good to know. | Glomerular filtration and absorption relatively low until 1-2 years old. Infants more susceptible to fluid volume excess and dehydration.
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| lack of fat padding | more susceptible to trauma in children due to
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| Renal biopsy | diagnose extent of kidney disease.
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| Urodynamics | determines the rate of urine flow by volume and pressure
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| Uroflowmetry | efficiency of urination.
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| Cystometrogram | graphic comparison of bladder pressure as a function of volume.
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| Voiding pressure study | comparison of detrusor contraction pressure, sphincter electromyelogram and urinary flow.
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| Cystoscopy | diagnosis of congenital abnormalities or acquired lesions in the bladder and lower urinary tract.
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| Urinary Tract Infections | common in children. Shorter urethra. Urinary stasis. 80% of cases are caused by Escherichia coli, followed by Klebsiella and Proteus.
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| Vesicoureteral Reflux | urine flows backwards from the bladder into the ureters during urination.
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| UTI Manifestations: Infants | Fever.
Weight loss.
Vomiting.
Increased voiding.
Foul-smelling urine.
Persistent diaper rash.
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| UTI Manifestations: Older children | Urinary frequency.
Pain during micturition.
Onset of bed wetting in a previously "dry" child.
Abdominal pain.
Hematuria.
Vomiting.
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| UTI Manifestations: With Renal Involvement | Fever, chills.
Flank pain.
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| Common antiinfective agents used for UTI | Penicillin’s.
Sulfonamide (trimethoprim and sulfisoxazole in combination).
Cephalosporins.
Nitrofurantoin.
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| Obstructive Uropathy | a condition in which the flow of urine is blocked, causing it to back up and injure one or both kidneys.
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| Hydronephrosis | distention of the renal pelvis because of an obstruction. The pelvis of the kidney becomes enlarged and cysts form. This may eventually damage renal nephrons, resulting in deterioration of
the kidneys.
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| Nephrotic Syndrome | refers to a number of different types of kidney conditions
that is distinguished by the presence of marked amounts of protein in the urine, edema, and hypoalbuminemia.
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| Nephritis: | More common in boys than girls, 2 to 8 years of age. Specific cause unknown, may be autoimmune. Prognosis good with steroid-responsive patients.
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| Acute Glomerulonephritis | Reaction to group A beta-hemolytic streptococcal infection.
May appear after scarlet fever or skin infections.
Most common form of glomerulonephritis in children; most often boys 6 - 7 years old.
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| Acute Glomerulonephritis: Pathophysiology | Glomerulus becomes inflamed and blocked, permitting RBC's and protein (normally retained) to enter the urine. Antibodies that are produced to fight the invading organisms also react against the glomerular tissue.
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| Acute Glomerulonephritis: Prognosis | may recover in 10 - 14 days; patients with protracted cases may show urinary changes for as long as one year but have complete recovery.
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| Acute Glomerulonephritis: Manifestations | 1-3 weeks after streptococcal infection has occurred.
Periorbital edema upon awakening.
Smoky brown or bloody urine.
Decrease urine output; elevated specific gravity with albumin, red and white blood cells.
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| Wilms Tumor | (Nephroblastoma) is an embryonal adenosarcoma.
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| Wilms Tumor: Treatment | Combination of surgery, radiation therapy, and chemotherapy.
Removal of kidney and tumor as soon as possible after diagnosed.
Avoid handling of the abdomen to prevent the spread of disease.
DO NOT PALPATE ABDOMEN!
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| Acute Renal Failure (ARF) | exists when the kidneys suddenly are unable to regulate the volume and composition of urine appropriately in response to food and fluid intake and the needs of the body.
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| principle feature of ARF | oliguria associated with azotemia, metabolic acidosis and diverse electrolyte imbalances.
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| Conditions that cause ARF | Glomerulonephritis.
Hemolytic-uremic syndrome.
Poor renal perfusion.
Urinary tract obstructions.
Acute renal injury.
Severe dehydration or other cause of poor perfusion.
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| Clinical Manifestations of ARF | Oliguria.
Anuria.
Nausea and vomiting.
Drowsiness.
Edema.
Hypertension.
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| signs of hyperkalemia are present, it is an emergency | Serum potassium in excess of 7 mEq/L.
Prolonged QRS complex.
Depressed ST segment.
High peaked T waves.
Bradycardia.
Heart block
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| The child with ARF is prone to developing | water intoxication and hyponatremia.
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| most immediate threat to a child with ARF | Hyperkalemia
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| Hyperkalemia can be minimized by: | Avoiding/eliminating potassium from all food and fluid.
Correcting acidosis.
Administering medication such as Kayexalate.
Hemodialysis or peritoneal dialysis.
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| Frequent complication of ARF in children | Hypertension
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| Chronic renal failure | occurs when the kidneys are no longer able to maintain the normal chemical structure of body fluids under normal conditions. Deterioration occurs over months or years and produces many clinical and biochemical disturbances that culminate in uremia.
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| Chronic renal failure: Pathophysiology | Early asymptomatic.
Midway ↑ numbers of nephrons are totally destroyed and most others are damaged there are definite biochemical abnormalities.
End stage kidneys no longer to maintain fluid and electrolyte imbalance.
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| features of uremic syndrome | Anorexia, nausea and vomiting.
Bruising.
Bloody diarrhea stools.
Stomatitis.
Bleeding from lips and mouth.
Intractable itching.
Uremic frost from deposits of urea crystals on the skin.
Deep respirations.
Hypertension and CHF.
Pulmonary edema.
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