renal disorder in children

1. Renal disorder in children
Dr:Ragaa Gasim Ahmed
Assistant professor in pediatric nursing
Al-Baha university

2. Objectives
By the end of this lecture the student will be
able to:
-Describe the kidney function and structure in
children
-Count acquired renal disorders in childhood
and nursing care
-Analyze haemolytic uraemic syndrome in
children
-Describe end-stage renal damage in children

3. Introduction

4. Kidney function in children
• The younger the child the more likely kidney function
is to be immature and relatively inefficient.
• The kidney:
• Filters blood to remove waste products
• Maintains fluid and electrolyte levels by selective
removal (or reabsorption) and elimination
• Helps to maintain blood pressure (renin)
• Helps to stimulate red blood cell production
(erythropoietin)
• Regulates calcium metabolism.
Renal function is vital to life

5. Kidney structure
• The kidneys are a pair of organs situated either side of the spine at the
back of the abdominal cavity at the level of T12 to L3 vertebrae
• Partially protected by 11th and 12th ribs and the perinephric fat
• Have a rich blood supply directly from the aorta via the renal arteries. Are
very vulnerable to hypoperfusion for any reason
• Superficial renal cortex and innermost renal medulla form 14–16 renal
nodes
• These contain the filtering and resorbtion functions at the level of the
nephron
• Urine formed during this process is drained into the renal pelvis and via
the ureter into the bladder for excretion.

6. Structural renal disorders
• Prenatal malformation or non-formation can lead
to abnormalities such as horseshoe kidney
• Strictures in the renal arteries may lead to
hypertension
• Strictures in the renal drainage system can lead
to damming back of urine and subsequent
pressure damage
• Ineffective vesicoureteric valves can lead to
reflux of urine from the bladder back up the
ureters, leaving the child vulnerable to disturbed
function and infection.

7. Acquired renal disorders in childhood
Post-streptococcal glomerulonephritis
•This is an immune response to a streptococcal infection (e.g. throat or
skin infection) leading to renal damage with reduced function.
•It generally resolves spontaneously but sometimes monitoring and
supportive therapy is necessary.
Nephrotic syndrome
•Produced by a number of disease processes
•Leads to damage of the filtering apparatus leading to increased
permeability allowing protein to be filtered and lost
•Proteinurea and low blood protein
•Causes fluid shifts in the body leading to the characteristic oedema
•Generally amenable to treatment with corticosteroids.

8. Nursing care
• Make sure that child and family understand
what is happening, what to expect and how
they can be involved
• Monitor constituents of the urine – urinalysis
• Monitor weight
• Monitor fluid intake and output
• Integrity of skin and oedematous tissue.

9. Haemolytic uraemic syndrome
• Rare but important cause of severe kidney
damage in childhood
• Often seen in the wake of infection with
Escherichia coli
• Severely unwell child
• Can lead to acute renal injury and subsequent
end-stage renal damage.

10. Renal tract infection
• Children are particularly vulnerable; the younger the
more vulnerable
• Symptoms include fever, pain, vomiting
• May be recurrent, requiring cause to be investigated;
diagnostic imaging may be required
• All children with a fever of unknown origin higher
than 38°C should have a urine sample tested
• Clean catch or urine collection pad should be used
• Treatment is by appropriate antibiotic therapy.

11. Acute renal injury (failure(
• Wide range of causative factors (e.g. reduced blood
supply (hypovolaemia, hypotension), toxins, physical
injury, obstruction)
• As the kidney’s vital functions are disturbed or lost
the child becomes globally unwell; lassitude loss of
appetite and vomiting headache, disruptions in vital
functions – vital signs
• Treatment is based on the underlying cause. May be
reversible but may lead to chronic disturbed
function.

12. End-stage renal damage (chronic
renal failure(
• Devastating end-point of any of the processes that
lead to kidney damage beyond repair
• Severe reduction of glomerular filtration rate for
more that 3 months
• Treatment based on which systems are primarily
affected
• Long-term supportive nursing is geared to maximal
child and family independence in management and
minimizing disruption to child and family life and
experience.

13. Renal replacement therapy
Dialysis
Haemodialysis:
•Blood is filtered mechanically to remove waste
products and excess water
•Requires venous access
•Requires around three sessions per week, each
lasting around 4 hours.

14. Cont
• Peritoneal dialysis:
• Fluid is instilled into peritoneal cavity to use the peritoneum
as a filtering membrane
• Adjustment of the composition of the dialysate produces
removal of waste products and excess water through osmosis
• Needs to be performed around four times a day with a dwell
time of around 30 minutes. Alternatively, may be carried out
overnight.
• Both forms are vulnerable to complications such as infection.
• This therapy can be severely disruptive to the child’s and
family’s lifestyle.
• Both forms still require some restrictions to fluid intake and
nutrition.

15. Cont
• Kidney transplantation
• Kidney function can be restored with a
successful renal transplant.
• Rejection remains a risk as the body’s
defensive immune reaction to ‘foreign’ tissue.
• This requires long-term suppressant
medication.

16. Tumours
• Some, such as Wilm’s (nephroblastoma), characteristically
occur in childhood
• Affects around 70 children per year in the United Kingdom
• Most often detected as a painless swollen abdomen
• Usually unilateral
• Depending on the stage at detection, the chance of recovery
is good; around 90% at 5 years
• Treatment involves surgery and possibly radiotherapy and/or
chemotherapy.

17. Tests used in renal disorders
• Prenatal testing (e.g. structural scan with
diagnostic ultrasound)
• Diagnostic imaging, X-ray ± contrast media
• Urinalysis – NB blood, protein
• Blood chemistry – electrolytes, blood protein
levels, etc.

18. Conclusion

19. References
• Alan Glasper, Jane Coad, Jim Richardson.
(2015). Children and Young People’s Nursing
at a Glance. Library of Congress Cataloging