Renal Problems of Children Lecture 7 Major Functions of the Kidney filtration and reabsorption Fluid balance electrolyte regulation acid base balance Erythropoietin production RBC production Can see problems with anemia BP regulation if kidneys aren t working BP wont be right Metabolic waste excretion Metabolism of vitamin D Bladder capacity 20 50mL All kidney neurons present at birth cannot grow more Efficiency increases with age more efficient after age 2 Fluid and Electrolyte Balance Ratio of body water to body weight varies Infants 45 extracellular fluid Children have higher amounts of water in extracellular fluids than adults Cannot conserve water as well has diminished fluid reserve Results in dehydration or hypovolemia Metabolic rate 2 3 times higher than adult growth is dependent on this Increases work of the kidneys School age closer to adult fluid distribution Pediatric Renal Function Infants have nephrons equal to adults shortly after birth but not mature Ability to concentrate urine improves Minimal output differs with age 2 5ml kg hr considered normal 2 years 1ml kg hr Structurally short urethra in child increases risk of UTI Particularly in girls Want info on I O as well as daily weight of the child Urine Function Studies Subjective data collection what do you SEE Objective data collection specific gravity normal 1010 1030 Urine dipstick test collecting urine from diaper weight diaper gram mL subtract dry weight from the wet diaper first pediatric urine collector pediabag urine analysis urine culture clean may need to be catheterrized IV pyelogram checks structures using dye inserted into child Voiding cystourethrogram BUN Creatinine Serum creatinine most reliable indicator of kidney function not influenced by diet or fluid intake or anything else actual reading of muscle metabolism weight products normal ratio of BUN to creatinine is 10 1 if both are increased then renal disorder is present then examined together Urinary Tract Infections One of the most common bacterial diseases and mainly nosocomial Children have shorter urethra higher in kids More common in females of all ages Classified according to region affected Cystitis lower UTI Prevent from becoming an upper UTI Pyelonephritis upper UTI Up into the kidneys Pathogens enter by 2 routes ascending from perionial or from blood Viral bacterial or fungal Acute or chronic Risk Factors for UTI Female Short urethra proximity of anus More common in males during the first 3 months because of uncircumcised males Hygiene teach this Risk factors Reflux urine backs up obstruction incomplete emptying of bladder bubble baths anything irritating diapers not changed enough Causes bacteria chemotherapy radiation metabolic disorder must look at path for UTI Symptoms newborns smell fussy irritable many asymptomatic fever or temp decrease below normal failure to thrive V D toddler more classic symptoms may hold urine because it hurts fuss when voiding older child same as toddler cystitis more common upper UTI fever chills abdominal pain flank pain CVA tenderness N V dehydration not feeling well at all Clinical Considerations Most common UTI Cystitis Inflammation of urinary bladder Dysuria urgency pain fever lethargy Treatment Antibiotics to prevent glomerulonephritis Pyridium makes urine not hurt burn Force fluids Increase Vitamin C Toileting hygiene teaching to avoid repeats Enuresis Repeated involuntary urination after 5yr Typically at night primary child never achieved complete bladder control more often seen more in boys than girls usually have a small bladder or neurologic delay in control not really related to stress secondary lost control after achieving linked to traumatic event or perceived traumatic event have been dry for at least 6 months can be a sign of infection 80 related to sleep disorder very difficult to arouse sleep to deep especially with obesity sleep apnea Interventions varies with the underlying cause food allergies can contribute to deep sleep decrease fluid intake after 5pm drug tofrinel Hypospadias Congenital anomaly of penis where the urethral opening is malpositioned This shortens the distance to the bladder Assessment careful with newborn see where urethra opening is Interventions DO NOT CIRCUMCISE even if just suspected keep area clean reconstructive surgery done around 2 years traumatic after potty training foley catheter inserted Undecended Testes Testes descend to scrotum in final trimester of pregnancy Body temp is higher in abdomen then scrotom so the testical will lose function and child will be infertile may take 2 weeks after birth to descend if left in abdominal cavity after age 5 seminiferous tubules may degenerate can be confused with testicular torsion extreme pain surgical emergency cuts out blood supply to testes worried about infertility Assessment Palpate for testes they can go up or down Do by age 1 Interventions Acute Poststreptococcal Glomerulonephritis APSG RELATED TO STREP Post infectious disease resulting from immune complex formation Usually StrepB More males then females mild cold or just haven t felt good Metabolic waste retention Orbital edema wake up with puffy eyes and would not go away Clinical signs symptoms SOB mild ha weakness flank pain Proteinuria oliguria less urine output hematuria BUN creatinine Can progress to edema CHF BP Diagnostics for APSG Typically appears 10 14 days after infection Urinalysis cola colored urine protein and RBCS rise in specific gravity Electrolytes elevated BUN Creatinine kids will complain of dizziness progressive edema and increased BP Antistreptolysen O Titer ASO Antibody that appears 10 14 days after onset Present for 4 6 weeks Complications significant Hypertensive encephalopathy consider signs symptoms look at them neurologically elevated BP increase ICP headaches not right level of conciousness Acute cardiac decompensation Again how would you assess look at profusion wont be good Slow capillary refill Blood pressure is decreaseeing acute renal failure Acute renal failure Metabolic waste retention No urine output Management of APSG Fluid volume excess with edema restrict Na daily weight AND I O watch electrolytes want good cerebral profusion check vision are they dizzy Risk for infection prophylactic antibiotics prevents further renal infection teaching avoid contact with other people tend to be homeschooled Nutritional restrictions restrict protein if BUN Creat as it comes down they can have more protein restrict K if oliguria low