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Pediatric Renal Study Guide
Renal System Overview
Function : Maintains fluid and electrolyte balance Organs : Kidneys, ureters, bladder, urethra Normal Urine Output : 0.5–2 mL/kg/hour Common Pediatric Concerns : High incidence in girls; frequent cause of hospitalization
Assessment of the Renal System
Health History : UTI history, voiding patterns, recent infections Physical Exam : Abdominal palpation, edema, genital exam Medications : Antibiotics, anticholinergics, antispasmodics Procedures/Surgeries : Urologic history Hygiene : Front-to-back cleaning, toilet habits Toilet Training : Assess developmental stage Normal UA Values : o pH: 5– o Specific gravity: 1.001–1. o Protein: <20 mg/dL
Urinary Tract Infection (UTI)
Cause : Mostly E. coli (85%) Symptoms : o Abdominal or back pain o Nausea, vomiting o Foul-smelling urine o Urgency, frequency, incontinence o Fever (infants) Diagnosis : Urinalysis Treatment : o Antibiotics (start before culture returns) o Increase fluids o Eliminate constipation o Ensure hygiene and frequent voiding
o Use bladder scans to check retention Complications : Pyelonephritis , urosepsis
Vesicoureteral Reflux (VUR)
Definition : Retrograde urine flow from bladder to kidneys Risks : Familial pattern, recurrent UTIs Complications : Pyelonephritis, renal scarring Grades : I to V Management : o May resolve on its own o Prophylactic antibiotics o Surgical correction for severe cases (Grades IV–V)
Acute Post-Streptococcal Glomerulonephritis (APSGN)
Symptoms : o Facial/periorbital edema (morning) o Anorexia, lethargy, pallor o Oliguria, tea-colored urine, hematuria o Mild proteinuria, hypertension, headache Labs : o Positive ASLO titer o Elevated BUN & creatinine Management : o Treat strep if active o Monitor weight, I&O, neuro status o Antihypertensives o Low sodium diet, possible fluid restriction
Nephrotic Syndrome
Symptoms : o Generalized edema, weight gain o Periorbital/facial edema, ascites o Proteinuria, dark frothy urine o Hypoalbuminemia, normal BP Treatment :
o No riding toys o Monitor for signs of infection and ensure urine output
Acute Kidney Injury (AKI)
Definition : Sudden decline in kidney function, leading to accumulation of waste products and electrolyte imbalance Causes : o Dehydration o Hemolytic Uremic Syndrome o Sepsis o Nephrotoxic medications Symptoms : o Oliguria or anuria o Edema, fatigue, confusion o Nausea, vomiting o Hypertension Labs : o Elevated BUN and creatinine o Electrolyte disturbances (e.g., hyperkalemia) Management : o Treat underlying cause o Monitor fluid balance, I&O o Electrolyte management o Dialysis if necessary
Chronic Kidney Disease (CKD)
Definition : Progressive and irreversible loss of kidney function lasting >3 months Causes : o Congenital abnormalities o Recurrent UTIs or glomerulonephritis o Hereditary disorders Symptoms : o Fatigue, poor appetite, growth failure o Polyuria progressing to oliguria o Nausea, bone pain, hypertension Labs : o Persistent proteinuria o Elevated BUN/creatinine
o Anemia Management : o Monitor growth and development o Dietary modifications (low sodium, phosphorus) o Manage anemia with erythropoietin o Dialysis or kidney transplant when advanced
Hypospadias and Epispadias
Definition : Urethral opening in abnormal location Assessment : o Inspect all male newborns o Do not circumcise until evaluated Treatment : o Surgical correction before toilet training Postoperative Care : o Protect stent o No tub baths until healed o Blood-tinged urine normal initially o Double diapering o No riding toys o Monitor for signs of infection and ensure urine output
Acute Kidney Injury (AKI)
Definition : Sudden decline in kidney function, leading to accumulation of waste products and electrolyte imbalance Causes : o Dehydration o Hemolytic Uremic Syndrome o Sepsis o Nephrotoxic medications Symptoms : o Oliguria or anuria o Edema, fatigue, confusion o Nausea, vomiting o Hypertension Labs : o Elevated BUN and creatinine o Electrolyte disturbances (e.g., hyperkalemia)
o No riding toys o Monitor for signs of infection and ensure urine output
Acute Kidney Injury (AKI)
Definition : Sudden decline in kidney function, leading to accumulation of waste products and electrolyte imbalance Causes : o Dehydration o Hemolytic Uremic Syndrome o Sepsis o Nephrotoxic medications Symptoms : o Oliguria or anuria o Edema, fatigue, confusion o Nausea, vomiting o Hypertension Labs : o Elevated BUN and creatinine o Electrolyte disturbances (e.g., hyperkalemia) Management : o Treat underlying cause o Monitor fluid balance, I&O o Electrolyte management o Dialysis if necessary
Chronic Kidney Disease (CKD)
Definition : Progressive and irreversible loss of kidney function lasting >3 months Causes : o Congenital abnormalities o Recurrent UTIs or glomerulonephritis o Hereditary disorders Symptoms : o Fatigue, poor appetite, growth failure o Polyuria progressing to oliguria o Nausea, bone pain, hypertension Labs : o Persistent proteinuria o Elevated BUN/creatinine
o Anemia Management : o Monitor growth and development o Dietary modifications (low sodium, phosphorus) o Manage anemia with erythropoietin o Dialysis or kidney transplant when advanced
Hypospadias and Epispadias
Definition : Urethral opening in abnormal location Assessment : o Inspect all male newborns o Do not circumcise until evaluated Treatment : o Surgical correction before toilet training Postoperative Care : o Protect stent o No tub baths until healed o Blood-tinged urine normal initially o Double diapering o No riding toys o Monitor for signs of infection and ensure urine output
Acute Kidney Injury (AKI)
Definition : Sudden decline in kidney function, leading to accumulation of waste products and electrolyte imbalance Causes : o Dehydration o Hemolytic Uremic Syndrome o Sepsis o Nephrotoxic medications Symptoms : o Oliguria or anuria o Edema, fatigue, confusion o Nausea, vomiting o Hypertension Labs : o Elevated BUN and creatinine o Electrolyte disturbances (e.g., hyperkalemia)
