Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 1

Alterations of Renal and Urinary Tract Function in Children

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

Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 3

Hypospadias

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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)

Mosby items and derived items © 2012 Mosby, Inc., an imprint of Elsevier Inc. 19

Vesicoureteral Reflux (VUR) (cont’d)

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

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

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