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Children and urinary
 

Children and urinary

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    Children and urinary Children and urinary Presentation Transcript

    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1 Alterations of Renal and Urinary Tract Function in Children
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 2 Structural Abnormalities  Horseshoe kidney  Hypospadias  Chordee  Epispadias  Exstrophy of the bladder
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3 Hypospadias
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 4 Structural Abnormalities  Bladder outlet obstruction  Ureteropelvic junction obstruction (UPJ)  Secondary UPJ  Hypoplastic or dysplastic kidneys  Renal aplasia or dysplasia  Polycystic kidney disease  Renal agenesis  Unilateral or bilateral (Potter syndrome)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 5 Glomerular Disorders  Glomerulonephritis  Immunoglobulin A (IgA) nephropathy  Nephrotic syndrome  Hemolytic uremic syndrome
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 6 Glomerulonephritis  Acute poststreptococcal glomerulonephritis  Occurs after a throat or skin infection with certain strains of group A alpha-hemolytic streptococci  Experience a sudden onset of hematuria, edema, hypertension, and renal insufficiency
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 7 Glomerulonephritis (cont’d)  Acute poststreptococcal glomerulonephritis (cont’d)  Antigen-antibody complexes and complement are deposited in the glomerulus  The immune complexes initiate inflammation and glomerular injury
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 8 Glomerulonephritis (cont’d)  Immunoglobulin A (IgA) nephropathy  IgA nephropathy is characterized by the deposition of mostly IgA but some IgM antibodies and complement in the mesangium of the glomerular capillaries
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 9 Glomerulonephritis (cont’d)  Henoch-Schönlein purpura nephritis  Also referred to as anaphylactoid purpura  IgA nephropathy that causes inflammation and damage to the glomerular blood vessels
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 10 Nephrotic Syndrome  Nephrotic syndrome is a symptom complex related to loss of protein in the urine  Minimal change nephropathy (MCN)  Focal segmental glomerulosclerosis (FSGS)  Congenital nephrotic syndrome  Nephrotic syndrome can be primary or secondary in relation to cause
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 11 Hemolytic-Uremic Syndrome (HUS)  Characterized by hemolytic anemia, thrombocytopenia, acute renal failure  HUS is the most common cause of acute renal failure in children  There is an association of HUS with bacterial and viral agents  Escherichia coli
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 12 Hemolytic-Uremic Syndrome (HUS) (cont’d)  The bacterial toxin from E. coli damages red cells and endothelial cells  The endothelial lining of the glomerulus becomes swollen and occluded with fibrin clots
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 13 Hemolytic-Uremic Syndrome (HUS) (cont’d)  The damaged red cells are removed from the circulation by the spleen, causing acute hemolytic anemia  The microcirculation develops numerous thrombi
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 14 Hemolytic-Uremic Syndrome (HUS) (cont’d)  Manifestations:  Sudden onset of pallor, bruising or purpura, irritability, and oliguria  Slight fever, anorexia, vomiting, diarrhea (with the stool characteristically watery and blood stained), abdominal pain, mild jaundice, and circulatory overload
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 15 Hemolytic-Uremic Syndrome (HUS) (cont’d)  Seizures and lethargy indicate CNS involvement  Renal failure is apparent within the first days of onset, causing metabolic acidosis, azotemia, hyperkalemia, hypertension
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 16 Urinary Tract Infections (UTIs)  UTIs are common 7- to 11-year-old girls  E. coli, the most common pathogen, ascends the urethra in cystitis or the ureter in pyelonephritis  Cystitis  Acute and chronic pyelonephritis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 17 Vesicoureteral Reflux (VUR)  Retrograde flow of urine from the bladder into the ureters  Reflux encourages infected urine from the bladder to be swept up into the kidneys  Leads to frequent pyelonephritis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 18 Vesicoureteral Reflux (VUR) (cont’d)  Caused by a congenital abnormality or ectopic insertion of the ureter into the bladder  Diagnosed by a voiding cystourethrogram (VCUG) and an intravenous pyelogram (IVP)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19 Vesicoureteral Reflux (VUR) (cont’d)
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 20 Nephroblastoma/Wilms Tumor  Wilms tumor is an embryonal tumor of the kidney  Wilms tumor arises from the proliferation of abnormal renal stem cells  Inherited and sporadic forms  Usually found by parent due to abdominal swelling
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 21 Incontinence/Enuresis  Involuntary passage of urine by a child who is beyond the age (4 to 5 years old) when voluntary bladder control should have been acquired  Primary enuresis  The child has never been continent  Secondary enuresis  Daytime enuresis  Nighttime enuresis
    • Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 22 Enuresis  Theories:  Organic causes  Factors that increase urine production  Maturational lag  Genetic factors  Sleep patterns  Psychosocial theories