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Children and urinary
- 1. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1
Alterations of Renal and Urinary
Tract Function in Children
- 2. 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
- 3. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3
Hypospadias
- 4. 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)
- 5. 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
- 6. 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
- 7. 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
- 8. 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
- 9. 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
- 10. 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
- 11. 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
- 12. 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
- 13. 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
- 14. 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
- 15. 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
- 16. 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
- 17. 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
- 18. 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)
- 19. Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19
Vesicoureteral Reflux (VUR)
(cont’d)
- 20. 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
- 21. 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
- 22. 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