Genitourinary System: Chapter 26

• Chapter 26 covers the Genitourinary System

Normal Urinalysis

• pH should be between 5.0 and 8.0
• Specific gravity should be between 1.001 and 1.030
• Should not contain glucose, ketones, proteins, or nitrates
• Microscopic tests should not show RBCs, WBCs, casts, or bacteria

Normal Characteristics of Urine

• Appearance should be pale yellow to deep gold
• Should be clear
• Newborn production rate is about 1-2 ml/kg/hr
• Child production rate is about 1 ml/kg/hr

Assessment of Renal Function

• Includes lab tests, x-rays, and ultrasound (U/S)
• Lab tests include culture and sensitivity (C and S)
• Imaging includes renal and bladder ultrasound, voiding cystourethrography (VCUG), and radionuclide (nuclear) cystogram
• A renal biopsy may be performed
• Normal BUN levels are 4-18 mg/dl
• Normal creatinine levels are 0.2-1.0 mg/dl
• Urinalysis (UA) is the single most important test

Clinical Manifestations of Urinary Tract Disorders or Disease

• Poor feeding
• Vomiting
• Frequent urination
• Failure to gain weight
• Painful urination
• Foul-smelling urine
• Enuresis
• Fatigue
• Blood in urine

Specimen Collection Methods

• Urine bags
• Disposable diapers with cotton balls
• Supra-pubic tap
• Catheterization

Urinary Tract Infection (UTI)

• One of the most common conditions of childhood
• E-coli is the cause in 80% of cases
• Other causes include staph, proteus, klebsiella, pseudomonas, haemophilis
• More common in females than males
• Urinary stasis is the most frequent cause
• Prevention is key

Pediatric Symptoms of UTI

• Frequency or urgency
• Fever in some cases
• Odiferous urine
• Blood or blood-tinged urine
• Wetting
• Stomachaches
• Vomiting

Drugs for UTIs

• Penicillins
• Sulfonamide
• Cephalosporins
• Nitrofurantoin

UTI Prevention

• Cleanse from front to back
• Void as soon as the urge is felt
• Urinate after intercourse
• Avoid tight clothing
• Wear cotton panties
• Empty the bladder completely
• Avoid straining
• Maintain generous fluid intake

Glomerular Disease

• Refers to diseases affecting the glomeruli of the kidneys

Nephrotic Syndrome

• Can be a primary disease
• This includes idiopathic nephrosis, childhood nephrosis, and minimal-change nephrotic syndrome
• Can be a secondary disorder:
• Clinical manifestation after or in association with glomerular damage with a known or presumed cause
• Can be a congenital form
• Inherited as an autosomal recessive disorder

Nephrotic Syndrome Pathophysiology

• Typically affects children aged 2-7 years
• The glomerular membrane becomes permeable to proteins

Nephrotic Syndrome Diagnostic Evaluation

• Clinical manifestations
• Edema
• Massive proteinuria, higher than 2+ on urine dipstick
• Low total serum protein, low serum albumin, elevated plasma lipid level
• Urine alterations

Nephrotic Syndrome Therapeutic Management

• Dietary restrictions
• Corticosteroids as the first line of therapy
• Diuretics
• 25% albumin infusion
• Antibiotics for acute infections

Nephrotic Syndrome Nursing Management

• Monitor fluid retention
• Track intake and output
• Monitor vital signs
• Manage the diet
• Implement fluid restriction if required
• Encourage appropriate activities
• Be aware of elevated risk for infection

Acute Glomerulonephritis (AGN)

• Most cases are postinfectious, specifically acute poststreptococcal glomerulonephritis (APSGN)
• It is the most common postinfectious renal disease in childhood
• Peak age of onset is 6-7 years

Acute Glomerulonephritis (AGN) Characteristics

• Glomeruli become edematous, leading to decreased plasma filtration and excessive accumulation of water/retention of sodium
• Urinalysis (UA) shows hematuria and proteinuria
• ASO titer/anti streptolysin O titer is positive
• Azotemia

Glomerulonephritis Symptoms

• Generalized edema due to decreased glomerular filtration that begins with periorbital area
• Progresses to lower extremities and then to ascites
• Urine is cloudy and smoky brown
• Oliguria occurs
• Hypertension can result from increased extracellular fluid and increased renin

Acute Glomerulonephritis (AGN) Management

• Possible dietary restrictions
• Monitor vital signs, weight, I & O
• Administer medications like antihypertensives, diuretics, and antibiotics
• Activity restriction is generally recommended

Acute Renal Failure (ARF)

• Kidneys suddenly unable to regulate volume and composition of urine
• It is not common in children
• The most common cause of transient renal failure results from severe dehydration
• A principal feature is oliguria
• Associated with azotemia, metabolic acidosis, and electrolyte disturbances

Acute Renal Failure (ARF) Treatment

• Pathophysiology is usually reversible
• Review history, BUN, serum creatinine, pH, sodium, potassium, and calcium
• Treat the underlying cause
• Monitor Input & Output and maintain fluid balance while monitoring vital signs
• Limit fluid intake
• Offer Food rich in concentrated carbohydrates and fats
• Diet of low protein, Na, and K
• Supply IV amino acids if experiencing nausea and vomiting

Complications of Acute Renal Failure (ARF)

• Hyperkalemia that can be treated with sodium polystyrene sulphate (kayexalate)
• Hypertension
• Anemia
• Seizures
• Cardiac failure with pulmonary edema

Acute Renal Failure (ARF) Nursing Management

• Monitor I & O
• Monitor vital signs
• Enforce fluid restrictions
• Monitor IV infusion
• Maintain optimal thermal environment
• Monitor for changes in behavior
• Provide family support