Renal

Published on Nov 18, 2015

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PRESENTATION OUTLINE

Renal

Genitourinary Dysfunction
Photo by Andrew Huff

Renal Assessment

History Taking and observation of symptoms
Photo by St. Murse

UTI- very common in childhood

A UTI can lead to a Kidney infection
https://www.khanacademy.org/science/health-and-medicine/human-anatomy-and-p...

Urinary tract infections
Infection of the urinary tract: one of the most common conditions of childhood
Often impossible to localize the infection
High incidence of infection among uncircumcised boys younger than 3 months
Photo by davis.steve32

Types of Urinary infection

  • recurrent
  • persistent
  • febrile
  • cystitis
  • pyelonephritis
  • urosepsis
Recurrent: repeated episodes
Persistent: bacteriuria despite antibiotics
Febrile: typically indicates pyelonephritis
Cystitis: inflammation of the bladder
Pyelonephritis: upper urinary tract and kidneys
Urosepsis: bacterial illness; urinary pathogens in blood
Photo by estherase

the usual suspects of UTI

organisms

  • Escherichia coli 80%
  • Proteus organisms
  • Pseudomonas organisms
  • Klebsiella organisms
  • Staphylococcus aureus
  • Haemophilus organisms
  • Coagulase-negative staphylococci
Photo by Andwar

suspicion

when should you suspect a uti?
Any child who exhibits the following should be evaluated
Incontinence in a toilet-trained child
Strong or foul-smelling urine
Frequency or urgency

Nephrotic Syndrome

there will be protein in the urine!
Clinical state
Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema
Massive urinary protein loss

Primary disease
Also known as
“Idiopathic nephrosis”
“Childhood nephrosis”
“Minimal nephrotic syndrome”

Secondary nephrotic syndrome
In association with glomerular damage

Congenital nephrotic syndrome
Autosomal recessive disorder

treatment

of Nephrotic Syndrome
Primary disease
Also known as
“Idiopathic nephrosis”
“Childhood nephrosis”
“Minimal nephrotic syndrome”
Secondary nephrotic syndrome
In association with glomerular damage
Congenital nephrotic syndrome
Autosomal recessive disorder


http://emedicine.medscape.com/article/982920-treatment

Risk for infection
Loss of appetite
Salt restriction
Fluid restriction
Activity adjustment
Family support and home care

Glomerulonephritis

Latent period of 10-21 days
GLOMERULONEPHRITIS

Oliguria, edema, hypertension
Hematuria
Bleeding in upper urinary tract causes urine to appear smoky
Proteinuria
Increased amount of protein reflects increased severity of renal disease
Prognosis of Glomerulonephritis

Almost all children with a diagnosis of acute poststreptococcal glomerulonephritis recover completely
Specific immunity is conferred
Subsequent recurrences are uncommon
Some children have been reported to develop chronic disease

I&O critical

Daily WEights, abdominal Girth

Fluid Restriction

Low sodium diet

Hemoltic-Uremic

Syndrome
Pathophysiology
Uncommon acute renal disease
Diagnostic evaluation
Anemia, thrombocytopenia, renal failure
Therapeutic management
Prognosis
Recovery rate of 95%
Photo by scooterdmu

Wilms' Tumor

nephroblastoma DO NOT PALPATE ABDOMEN!!!
Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma, Wilms' tumor is the most common cancer of the kidneys in children. Wilms' tumor most often affects children ages 3 to 4 and becomes much less common after age 5.

Wilms' tumor most often occurs in just one kidney, though it can sometimes be found in both kidneys at the same time.

Improvements in the diagnosis and treatment of Wilms' tumor have improved the prognosis for children with this disease. The outlook for most children with Wilms' tumor is very good.

most common in African American boys at age 3

renal failure

Acute renal failure (ARF)
Inadequate perfusion
Kidney disease
Urinary tract obstruction


Chronic renal failure (CRF)
Long-standing kidney disease
Congenital anomaly
Photo by pj_vanf

oliguria?

think renal failure
Acute Renal Failure....
Definition: kidneys suddenly unable to regulate volume and composition of urine
Not common in childhood
Principal feature: oliguria
Associated with azotemia, metabolic acidosis, and electrolyte disturbances
Most common pathologic cause: transient renal failure resulting from severe dehydration



Pathophysiology: usually reversible
Diagnostic evaluation
Patient: may be critically ill
Laboratory measurements
Therapeutic management
Treatment of underlying cause
Management of complications
Supportive therapy

complications

Definition: kidneys suddenly unable to regulate volume and composition of urine
Not common in childhood
Principal feature: oliguria
Associated with azotemia, metabolic acidosis, and electrolyte disturbances
Most common pathologic cause: transient renal failure resulting from severe dehydration

Complications:
Hyperkalemia
Hypertension
Anemia
Seizures
Hypervolemia
Cardiac failure with pulmonary edema

Chronic

more than 50% of renal capacity is destroyed
Photo by adamhenning

why?

what took out the kidneys
Congenital renal and urinary tract malformations
Vesicoureteral reflux associated with recurrent urinary tract infections
Hereditary disorder
Chronic pyelonephritis
Chronic glomerulonephritis
Anaphylactoid purpura, lupus erythematosus

doing the kidneys job

separates, colloid and crystalline through semipermeable membrane
Photo by duncan

Peritoneal Dialysis

preferred method for children
Abdominal cavity acts as semipermeable membrane for filtration
Warmed solution enters peritoneal cavity by gravity, remains for period of time before removal
Can be managed at home in some cases
Photo by SB Archer

3 times a week, 4-6 hours....

Photo by gainesp2003

Transplantation

primary goal long term survival of grafted tissue

Hannah Cilli

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