1. Pediatric GU Dysfunction
Assessment of pediatric renal function
Signs and symptoms
Laboratory tests
Radiological tests
Nursing considerations
Psychosocial and developmental considerations

2. GU Disorders and Defects
Urinary Tract Infection (UTI)
Vesicoureteral Reflux
Hypospadias
Nephrotic Syndrome
Acute Glomerular Nephritis
Hemolytic Uremic Syndrome
Wilm’s Tumor

3. Renal Failure
Acute
Chronic
Kidney transplantation

4. Urinary Tract Disorders Signs and Symptoms
Newborn
Poor feeding
Vomiting
Poor weight gain
Rapid respirations
Respiratory distress
Frequent voiding
Crying w/voiding

5. Urinary Tract Disorders Signs and Symptoms
Newborn (continued)
Jaundice
Spontaneous pneumothorax or pneumomediastinum
Seizures
Dehydration
Other anomalies
Enlarged kidneys or bladder

6. Urinary Tract Disorders Signs and Symptoms
Infant & toddler
Poor feeding, vomiting
Poor weight gain
Increased thirst
Frequent voiding
Crying with voiding
Foul-smelling urine
Pallor
Fever

7. Urinary Tract Disorders Signs and Symptoms
Infant & toddler (continued)
Persistent diaper rash
Seizures
Dehydration
Enlarged kidneys or bladder

8. Urinary Tract Disorders Signs and Symptoms
Childhood
Poor appetite
Vomiting
Growth failure
Excessive thirst
Enuresis, incontinence, frequent urination
Painful urination
Swelling of the face

9. Urinary Tract Disorders Signs and Symptoms
Childhood (continued)
Seizures or tetany
Pallor
Fatigue
Blood in urine
Abdominal or back pain
Edema
Hypertension

10. Urinary Tract Infection
Infection in the upper or lower tract
Females 10-30x risk of males
Urinalysis
Leukocyte esterase, nitrites, WBC and RBC counts, bacteria
Culture and Sensitivity
E. coli – 80% of cases

11. Anatomic and Physical Factors
Shorter urethra in females
2 – 6 years of age
Adolescents
Urinary stasis
Reflux
Anatomic abnormalities
Bladder compression
Dysfunctional voiding

12. Vesicoureteral Reflux

13. Vesicoureteral Reflux
Retrograde flow of urine from the bladder up the ureters
Conservative management - prophylactic antibiotics, routine urine cultures
Surgical management - reimplants

14. Hypospadias/Epispadias
Location of the urinary meatus behind the glans penis or anywhere on the penile shaft

15. Hypospadias/Epispadias
Circumcision delayed
Surgical correction by 1 year old
To enable voiding in standing position
Improve physical appearance
Sexual adequacy

16. Nephrotic Syndrome Primary - Minimal Change Nephrotic Syndrome
80% of all cases
Good prognosis
Secondary to another disorder
Congenital

17. Nephrotic Syndrome

18. Nephrotic Syndrome Goals Therapeutic Management
Reduce urinary protein excretion
Reduce tissue fluid retention
Prevent infection
Minimize complication
Therapeutic Management
Low salt diet
Corticosteroids
Albumin and lasix
Immunosuppressants

19. Acute Glomerulonephritis
Clinical Manifestations
Orbital edema (worse in AM)
Loss of appetite
Decreased urine output
Tea-colored urine
Antecedent streptococcal infection
Hypertension
Proteinuria

20. Acute Glomerulonephritis
Nursing Interventions
No added salt diet
Fluid restriction
Q4h BP
Daily weights
Close follow-up

21. Hemolytic Uremic Syndrome
Age 6 months – 5 years
Presents as viral illness followed by sudden onset of hemolysis and anemia
Anemia, thrombocytopenia and renal failure = HUS
95% recovery rate with prompt treatment
Can progress to chronic renal failure

22. Wilm’s Tumor Abdominal swelling or mass Usually 1 kidney (favors left)
Encapsulated for long period
Can become quite large
Treatment: surgical removal and chemotherapy

23. Wilm’s Tumor Post-op Care Monitor for:
Edema
Bowel sounds
Bowel movements
Abd. distention
Vomiting
Pain
Blood pressure
Urine output
Signs of infection

24. Acute Renal Failure Oliguria Nausea Vomiting Drowsiness Edema
Hypertension

25. Acute Renal Failure Resulting from:
Severe dehydration
Poor renal perfusion
Acute renal injury
Glomerulonephritis
HUS

26. Chronic Renal Failure Uremia Retention of waste products
Water and sodium restriction
Hyperkalemia
Metabolic acidosis
Anemia
Calcium & phosphorus disturbances
Growth disturbance

27. Chronic Renal Failure Calcium and Vitamin D Antihypertensives
Diuretics
Bicarbonate
Antiepileptics
Antihistamines
Epo

28. Treatment of CRF
Peritoneal Dialysis CAPD –continuous ambulatory CCPD – continuous cyclic

29. Treatment of CRF
Hemodialysis

30. Treatment of CRF Kidney Transplantation LRD – living related donor
CAD – cadaver donor

31. Renal Transplantation
Watch for
Fever
Swelling and tenderness over graft area
Decreased urine output
Elevated blood pressure