219 Questions
What is the major purpose of the kidneys?
Balancing body fluids and electrolytes
What is the process that produces urine in the kidneys?
Glomerular filtration
What is the function of erythropoietin produced by the kidneys?
Stimulating red blood cell production
What happens when there is a lack of erythropoietin due to significant kidney disease?
Decrease in red blood cell count leading to anemia
What is the current management approach for Vesicoureteral Reflux (VUR)?
Conservative management with monitoring and prophylaxis
What are the options for surgical management of VUR?
Endoscopic injection of a bulking agent or ureteric reimplantation
What is the range of cure rates for surgical management of VUR?
72 to 96%
What is the prognosis for UTI with prompt and adequate treatment?
Usually excellent
What should nurses instruct parents to consider in children with fever and urinary tract abnormalities?
The possibility of UTI
What are symptoms of UTI in infants?
Fussiness, crying, poor feeding, and vomiting
Why is obtaining an appropriate specimen essential for suspected UTI?
To accurately diagnose the infection
What may be performed to detect anatomical defects related to UTI?
Additional tests
What should nurses do in preparation for diagnostic and therapeutic procedures for children with UTI?
Prepare the children
What is indicated in treating UTI?
Antibacterial medications
What is included in the prevention of UTI?
Simple hygienic habits and prompt urination after intercourse for sexually active females
What is the recommended method to diagnose UTIs in young infants according to the Canadian Paediatric Society?
Suprapubic aspiration or urethral catheterization
What contributes to the increased incidence of bacteriuria in females?
Anatomical and physical factors of the lower urinary tract
Which category has an increased risk of UTI development, especially in the presence of urinary tract anomalies?
Uncircumcised males
What is the most common organism causing UTIs?
Escherichia coli
What type of urine specimen is required for the diagnosis of UTI?
Sterile specimen
What does an increased fluid intake promote in the bladder?
Flushing of the normal bladder
What is the most common age range for UTI occurrence in males?
First year of life
What is the term used to describe the presence of bacteria in the urine without symptoms?
Asymptomatic bacteriuria
What contributes to the rapid establishment of bacteria in the urethra, particularly in girls?
Holding or infrequent voiding patterns
What is the most common origin of uropathogens?
Gastrointestinal tract
What is the recommended method to obtain a urine specimen for diagnosing UTIs in young infants?
Suprapubic aspiration
What is the Cochrane Review's conclusion about the benefit of cranberry juice in preventing UTIs?
Too small to recommend its use
What stimulates angiotensin production and arteriole constriction?
Lowered blood volume, pressure, or increased catecholamine secretion
What comprises the kidney's functional unit?
Nephron
What forms the renal corpuscle?
Glomerulus and Bowman’s capsule
What influences the glomerular filtration rate (GFR)?
Osmotic pressure, hydrostatic pressure, and arteriole diameter
What is the amount of fluid filtered from the capillaries into the Bowman’s capsule called?
Glomerular filtration rate (GFR)
At what age do glomerular filtration and absorption reach adult levels?
1-2 years
How are glucose and amino acids reabsorbed by the tubules?
Active transport
What does antidiuretic hormone (ADH) promote?
Water reabsorption
What may failure to thrive in children indicate?
Impaired renal function
What are nurses responsible for in relation to renal conditions?
Observing children for manifestations of dysfunction, preparing them for tests, and maintaining careful intake and output and blood pressure measurements
What are urinary tract infections more significant in?
Infancy
What is crucial for detecting renal conditions?
Urine and blood tests, including routine urinalysis
Which test is a quick and inexpensive method for detecting UTI?
Dipstick tests for leukocyte esterase and nitrites
What is the main objective of UTI treatment in children?
Eliminate infection
What is the basis for antibiotic therapy in pediatric UTI?
Pathogen identification
When is renal/bladder ultrasound recommended for children with first febrile UTI?
For children over 2 years old
What may be necessary in infants with anatomical defects like VUR to prevent recurrent infection?
Surgical correction
What does VUR refer to?
Retrograde flow of urine from kidneys to bladder
What are the post-infection tests performed to identify kidney damage and anatomical abnormalities?
Ultrasonography and DMSA scan
What is the recommended antibiotic treatment duration for febrile UTI in children aged 2 months to 24 months?
7-10 days
What differs in the management of UTI between children under 24 months and older children?
Diagnostic workup
What may be necessary for older children with UTI after toilet independence?
Surgical correction
What are the tests performed post-infection to detect kidney damage and anatomical abnormalities?
Ultrasonography and DMSA scan
What is the risk associated with difficulty in urine collection in infants and small children?
False low organism count
Which of the following is NOT a potential characteristic of obstructive uropathy?
Increased incidence in girls
What is the primary consequence of damage to distal nephrons in chronic uropathy?
Metabolic acidosis
In children with obstructive uropathy, what may be necessary if there is early intervention for partial obstruction?
Surgical intervention
What is the term for the dilatation of the urinary tract detected prenatally in one in five pregnancies?
Hydronephrosis
What is the estimated percentage of affected children with a favorable prognosis in nephrotic syndrome?
80%
Which immunosuppressant medication may be considered for children who do not respond to steroid therapy in nephrotic syndrome?
Azathioprine
What are the complications of nephrotic syndrome mentioned in the text?
Infection, circulatory insufficiency, and thromboembolism
What is an important nursing function in the care of children with nephrotic syndrome according to the text?
Continuous monitoring of fluid intake and output
What is a potential trigger for relapses in children with Minimal Change Nephrotic Syndrome (MCNS) according to the text?
Viral or bacterial infection
What is the recommended method for monitoring progress in children with nephrotic syndrome according to the text?
Urine examination for albumin, daily weight, and measurement of abdominal girth
What may be necessary for children with severe scrotal swelling in nephrotic syndrome according to the text?
Use of scrotal sling
What is a constant source of danger to edematous children and those receiving corticosteroid therapy according to the text?
Infection
What is usually restricted during the edema phase and while the child is on steroid therapy in nephrotic syndrome according to the text?
Salt intake
What is an important part of the care of children with nephrotic syndrome according to the text?
Providing suitable recreational and diversional activities
What may create a perplexing issue for nurses in children with active nephrosis according to the text?
Loss of appetite
What may be necessary for children with severe edema in nephrotic syndrome according to the text?
Fluid restriction
What is the preferred surgical procedure for urinary tract obstruction in children?
Pyeloplasty
How is phimosis managed in infants and young boys?
Topical treatments
What is essential for managing phimosis in infants and young boys?
Proper hygiene and avoidance of forcible retraction
What is the term for the presence of peritoneal fluid in the scrotum?
Hydrocele
What is indicated for persistent communicating hydroceles?
Surgical repair
What is cryptorchidism?
Failure of one or both testes to descend normally
When do testes spontaneously descend in most cases?
By 6 months of age
What may be required for surgical correction of hydrocele?
Advising parents on post-operative swelling and activity restrictions for the child
What is indicated if the testes do not spontaneously descend by 6 months of age?
Surgical intervention
What may external defects of the genitourinary tract in children require?
Multiple operations, interprofessional care, and lifelong follow-up
What is the term for tight foreskin that may resolve on its own or require circumcision for pathological cases?
Phimosis
What is the preferred surgical procedure for urinary tract obstruction in children?
Pyeloplasty
Which condition may be associated with anorchism?
Congenital adrenal hyperplasia (CAH)
What is the recommended age for surgical treatment of cryptorchidism to improve fertility and reduce the risk of testicular cancer?
2 years
What is the common congenital penile defect that may require staged repair for severe cases?
Hypospadias
What is the condition resulting from the failure of urethral canalization and may require surgical correction?
Epispadias
What is the visible indication of bladder exstrophy in the suprapubic area?
Red mass with numerous folds
What is the primary aim of postoperative nursing care for pediatric urological surgical interventions?
Preventing infection and educating parents on home care
What is the condition characterized by absence of testes in the scrotum?
Cryptorchidism
What is the term for the surgical repositioning of palpable testes?
Orchiopexy
What is the recommendation for infants with hypospadias regarding circumcision?
Circumcision is not recommended
What is the primary aim of surgical correction for bladder exstrophy?
Correcting abnormal development of the bladder and abdominal wall
What is the recommended approach for the timing of surgical interventions for pediatric urological conditions?
Carefully timed and managed
What type of testes are found in the groin and may require annual monitoring?
Retractile testes
What is the primary characteristic of nephrotic syndrome?
Hyperlipidemia
At what age does the onset of minimal-change nephrotic syndrome (MCNS) predominantly occur?
1-3 years
What is the first line of therapy for MCNS?
Corticosteroids
What is a common manifestation of MCNS in children between 2 and 8 years of age?
Hematuria
What may be necessary if a patient does not respond to a 4- to 8-week course of steroids for MCNS?
Renal biopsy
What is the recommended method for diagnosing MCNS?
Diagnostic evaluation based on history, clinical manifestations, and laboratory findings
What dietary restrictions may be included in the management of MCNS?
Low-salt diet
What is a common adverse effect of steroid therapy for MCNS?
Weight gain
What is the aim of therapeutic management for MCNS?
Minimize therapy-related complications
What is a characteristic feature of MCNS relapses?
Proteinuria
What may be used for severe cases of MCNS?
25% albumin infusions
What is a potential consequence of failure to thrive in children with MCNS?
Delayed puberty
What is the peak age of onset for Acute Poststreptococcal Glomerulonephritis (APSGN)?
6 to 7 years
What is the latent period between streptococcal infection and the onset of clinical manifestations in APSGN?
10 to 21 days
When is APSGN associated with pyoderma (principally impetigo) more prevalent?
Later summer or early fall
What is the primary consequence of damage to distal nephrons in chronic uropathy?
Impaired urine concentration
What is the primary concern regarding tumour palpation in preoperative care for children with Wilms tumor?
Possible dissemination of cancer cells to adjacent and distant sites in the event of rupture
When does alopecia typically occur in children undergoing treatment for Wilms tumor?
Approximately 2 weeks after the initial treatment regimen
What are the major nursing responsibilities in the postoperative care of children with Wilms tumor?
Monitoring GI activity, blood pressure, urine output, signs of infection, and instituting pulmonary hygiene
When is it usually better to postpone telling the child about the adverse effects of treatment for Wilms tumor?
Until after surgery
What is a significant risk for children with Wilms tumor in terms of postoperative care?
Intestinal obstruction from vincristine-induced ileus, radiation-induced edema, and postsurgical adhesion formation
What is the timing of radiotherapy and chemotherapy in relation to surgery for children with Wilms tumor?
Usually begun immediately after surgery
What is the most important consideration for informing the family about the major benefits and adverse effects of treatment for Wilms tumor?
Timing of the information to avoid overwhelming the family
What is the primary aim of postoperative nursing care for children with Wilms tumor?
Preventing postoperative pulmonary complications
What is the most common presenting sign of Wilms Tumor?
Painless abdominal mass
Which kidney is more often involved in Wilms Tumor?
Left kidney
What is the cure rate for children with localized Wilms Tumors (stages I and II)?
90%
What is the duration range of chemotherapy therapy indicated for all children with Wilms Tumor?
6 to 15 months
What is the recommended surgical procedure for high-risk Wilms Tumor cases, metastasis, or unfavorable histological characteristics?
Radical nephrectomy
What is the primary therapeutic management for Wilms Tumor?
Combined treatment with surgery, chemotherapy, and sometimes radiation
What is the most common histological classification of Wilms Tumor cells?
Favorable
What is the potential indication for postoperative radiotherapy in Wilms Tumor cases?
High-risk cases
What is the primary diagnostic evaluation for Wilms Tumor?
Radiographic and imaging studies
What is the potential manifestation of Wilms Tumor if metastasis occurs?
Lung involvement
What is the primary aim of preoperative nursing care for children with Wilms Tumor?
Preparing the child and parents for procedures
What type of cells does Wilms Tumor arise from?
Primordial cells
Which of the following is a common cause of acquired acute kidney injury (AKI) in children?
Bacterial toxins
What is the primary site of injury in Hemolytic Uremic Syndrome (HUS)?
Glomerular capillaries
What is the estimated frequency of Wilms Tumour (WT) in children younger than 15 years?
7 cases per million
What percentage of Wilms Tumour (WT) cases occur in children younger than 5 years?
75%
What is the recovery rate for Hemolytic Uremic Syndrome (HUS) with prompt treatment?
95%
What are the long-term complications associated with Hemolytic Uremic Syndrome (HUS)?
Central nervous system disorders
What is the most common malignant renal and intra-abdominal tumor of childhood?
Wilms Tumour (WT)
What is the peak incidence age for Wilms Tumour (WT)?
2 to 3 years
What is the recommended therapeutic management for Hemolytic Uremic Syndrome (HUS)?
Pharmacological agents
What is a common association of Hemolytic Uremic Syndrome (HUS)?
Renal failure
What is a possible cause of Hemolytic Uremic Syndrome (HUS)?
Unpasteurized milk
What are the diagnostic features of Hemolytic Uremic Syndrome (HUS)?
Proteinuria and hematuria
What is the typical time frame for the onset of nephritis after streptococcal infection in APSGN?
1 to 3 weeks
What is the primary diagnostic indicator for APSGN?
Reduced serum complement (C3) activity
What is the recommended diagnostic test for monitoring disease improvement in APSGN?
Antistreptolysin O (ASO) titer
What is the rare requirement for diagnosis in APSGN?
Renal biopsy
What is the primary therapeutic management for children with APSGN?
General supportive measures
What is crucial for children with APSGN who develop acute kidney injury (AKI)?
Peritoneal dialysis
What is crucial for the therapeutic management of acute hypertension in APSGN?
Regular blood pressure measurements
What is indicated to prevent transmission of nephritogenic streptococci to family members in APSGN?
Antibiotic therapy
What is the prognosis for children with APSGN?
Uncommon recurrences
What is crucial for nursing care in children with APSGN?
Regular monitoring of vital signs
What is crucial due to the variable and unpredictable severity of the acute phase in APSGN?
Assessment of the child's appearance for signs of cerebral complications
What is crucial for children with APSGN who develop acute kidney injury (AKI)?
Peritoneal dialysis
Which of the following is a characteristic of uremia?
Retention of nitrogenous products producing toxic symptoms
What is the principal feature of Acute Kidney Injury (AKI)?
Oligoanuria
What is azotemia characterized by?
Accumulation of nitrogenous waste within the blood
When does Acute Kidney Injury (AKI) commonly occur?
Not common in childhood
What is the primary cause of cardiac failure with pulmonary edema in Acute Kidney Injury (AKI)?
Hypervolemia
What is the primary aim of postoperative nursing care for children with Wilms tumor?
Preventing urinary tract infections
What is the primary cause of Chronic Kidney Disease (CKD) in indigenous children in Canada?
Poorly controlled diabetes
What is the primary symptom of children with Chronic Kidney Disease (CKD) in early stages?
Asymptomatic
What is the primary complication of Acute Kidney Injury (AKI) in terms of fluid and electrolyte balance?
Hypervolemia
What is the primary factor affecting the prognosis of Acute Kidney Injury (AKI)?
Causative factor
What is the primary treatment for seizures in Acute Kidney Injury (AKI)?
Anticonvulsants
What is the primary cause of reduced resistance in children with Acute Kidney Injury (AKI)?
Infection
What is the primary cause of Chronic Kidney Disease (CKD) in children with hereditary disorders?
Glomerulonephropathy
What is the primary aim of meticulous nursing care for children with Acute Kidney Injury (AKI)?
Fluid balance monitoring
What is the primary symptom exhibited by children with Acute Kidney Injury (AKI) that requires supportive nursing care?
Anxiety
What is the primary aim of limiting fluid intake in Acute Kidney Injury (AKI) patients?
Coping with thirst
What is the primary cause of transient renal failure in children according to the text?
Severe dehydration
What is the most common complication of acute kidney injury (AKI) in children?
Hypertension
What is the recommended hemoglobin level threshold for transfusion in children with AKI?
60 g/L
How is hyperkalemia managed in patients with AKI according to the text?
Dietary restrictions
What is the primary aim of therapeutic management in AKI?
Treating the underlying cause
What is the main characteristic of AKI according to the text?
Significant reduction in GFR
What is the primary diagnostic indicator for AKI according to the text?
Elevated creatinine level
What is the most common cause of mortality in pediatric cases of AKI?
Uremia
How is poor perfusion from dehydration managed in patients with AKI?
Volume restoration
What is a significant concern in patients with AKI that requires careful monitoring and management?
Uremia
What is a common manifestation of AKI in terms of water balance according to the text?
Increased body weight
What is a potential consequence of damage to distal nephrons in chronic uropathy according to the text?
Metabolic acidosis
What are the primary current treatments for ESRD in children?
Dialysis and kidney transplantation
What are potential complications of dialysis in children with ESRD?
Infection, growth failure, and socialization disruption
What is becoming the optimal form of renal replacement therapy for children with ESRD?
Primary or pre-emptive kidney transplants
What is a significant stressor for children and families dealing with ESRD?
All of the above
What can adolescents undergoing hemodialysis experience?
Depression or hostility
What therapy offers a greater degree of freedom for long-term dialysis patients?
Continuous ambulatory peritoneal dialysis (CAPD)
What is the primary aim of nursing care for ESRD in children?
Improving quality of life
What can children and parents experience upon diagnosis of ESRD?
All of the above
What is the primary consequence of damage to distal nephrons in chronic uropathy?
Hypertension
What is the primary therapeutic management for children with APSGN?
Supportive care
What is the recommended method to obtain a urine specimen for diagnosing UTIs in young infants?
Suprapubic aspiration
What is the first line of therapy for Minimal Change Nephrotic Syndrome (MCNS)?
Steroid therapy
What is the primary aim of therapeutic management in irreversible renal failure?
Promote maximum renal function
What is the primary method for controlling dietary phosphorus in children with CKD?
Reducing milk intake
How is anemia corrected in CKD children?
Recombinant human erythropoietin and iron preparations
What is the primary method for managing hypertension in CKD children?
Antihypertensive medications
What is the primary method for addressing growth failure in CKD children?
Recombinant human growth hormone
What is the primary aim of diet regulation in CKD children?
Reduce the quantity of materials that require renal excretion
What is the primary method for controlling dietary protein intake in CKD children?
Limited to the reference daily intake for the child’s age
When are sodium and water usually limited in CKD children?
If there is evidence of edema or hypertension
What is the primary method for managing dietary phosphorus in CKD children?
Reducing protein and milk intake
What is the primary method for managing dental issues in CKD children?
Require regular dental care
What is the primary method for managing anemia in CKD children?
Recombinant human erythropoietin and iron preparations
What is the primary method for managing hypertension in CKD children?
Antihypertensive medications
Which type of dialysis is generally reserved for use in AKI, severe fluid overload, inborn errors of metabolism, or after bone marrow transplant?
Continuous venovenous hemofiltration
What is the preferred form of dialysis for infants, children, and parents who wish to remain independent, and for families who live a long distance from the medical center?
Peritoneal dialysis
In hemofiltration, what is circulated outside the body by hydrostatic pressure exerted across a semipermeable membrane with simultaneous infusion of a replacement solution?
Blood
What is the most common method for clinical management of renal failure?
Hemodialysis
What is the recommended frequency for hemodialysis in children?
Thrice a week for 4 to 6 hours
What is a potential adverse effect of hemodialysis in children?
Muscle cramping
What type of dialysis is best for children without someone able to perform peritoneal dialysis or living near a dialysis center?
Hemodialysis
What offers relatively normal life and is preferred for children with end-stage renal disease (ESRD)?
Kidney transplantation
What is a potential consequence of children receiving kidney transplant from living related or cadaver donors?
Rejection leading to retransplantation
What is the primary concern for families with children undergoing home peritoneal dialysis?
Risk of burnout
What is the recommended timing and frequency for peritoneal dialysis in children?
Depends on age and catheter type
What is the wait time for kidney transplant longer for, according to the text?
Indigenous children
What is the main reason for preferring hemodialysis for children without someone able to perform peritoneal dialysis or living near a dialysis center?
Rapid correction of fluid and electrolyte abnormalities
What is the primary role of nurse in home peritoneal dialysis for children?
Monitoring for burnout
What is the primary reason for recommending kidney transplantation for children with ESRD?
Relatively normal life
What is the primary concern for children receiving external vascular access devices?
Risk of infection
Study Notes
Pediatric Kidney Function and Dysfunction
- Renin is secreted by the kidneys in response to lowered blood volume, pressure, or increased catecholamine secretion, stimulating angiotensin production and arteriole constriction.
- Nephron is the kidney's functional unit, comprising a renal corpuscle and a renal tubule.
- Glomerulus and Bowman’s capsule form the renal corpuscle, with the glomerular capillary receiving blood from the afferent arteriole and passing it to the efferent arteriole.
- The glomerular filtration rate (GFR) is the amount of fluid filtered from the capillaries into the Bowman’s capsule, influenced by osmotic pressure, hydrostatic pressure, and arteriole diameter.
- The kidneys produce about 125 mL of glomerular fluid per minute, with most being reabsorbed.
- Glomerular filtration and absorption are relatively low in infants and reach adult levels at 1-2 years due to factors like epithelial cell shape and arteriole resistance.
- Substances are selectively reabsorbed by the tubules, with glucose and amino acids reabsorbed by active transport and water by osmosis.
- Antidiuretic hormone (ADH) increases the permeability of the distal tubule and collecting ducts, promoting water reabsorption.
- Renal abnormalities in newborns may be associated with various malformations, and failure to thrive in children may indicate impaired renal function.
- Urinary tract infections are more significant in infancy, and clinical manifestations of renal disease vary with the child’s age and maturation.
- Urine and blood tests, including routine urinalysis, are crucial for detecting renal conditions, and nurses play a key role in specimen collection and analysis.
- Nurses are responsible for observing children for manifestations of dysfunction, preparing them for tests, and maintaining careful intake and output and blood pressure measurements in those at risk for renal complications.
Pediatric Urinary Tract Infections and Vesicoureteral Reflux
- UTI diagnosis in children involves bacteriuria detection in urine culture, positive urinalysis, and symptom development
- Difficulty in urine collection in infants and small children, as well as the risk of false low organism count due to high fluid intake
- Dipstick tests for leukocyte esterase and nitrites are quick and inexpensive methods for detecting UTI
- Tests such as ultrasonography, VCUG, IV pyelogram, and DMSA scan are performed post-infection to identify kidney damage and anatomical abnormalities
- Objectives of UTI treatment in children: eliminate infection, identify contributing factors, prevent systemic spread, and preserve renal function
- Antibiotic therapy is based on pathogen identification, history of antibiotic use, and infection location
- New recommendations for managing UTIs in children aged 2 months to 24 months, including antibiotic treatment for 7 to 10 days for febrile UTI
- Renal/bladder ultrasound recommended for children over 2 years with first febrile UTI, voiding cystourethrogram not required unless ultrasound is abnormal
- Management of UTI differs between children under 24 months and older children, including the diagnostic workup and prevention of future infections
- Conservative measures and aggressive management of bladder and bowel dysfunction for older children with UTI after toilet independence
- Surgical correction may be necessary in infants with anatomical defects like VUR or bladder neck obstruction to prevent recurrent infection
- VUR refers to abnormal retrograde flow of urine from bladder to kidneys, can lead to kidney infection and is associated with renal scarring in children
Nephrotic Syndrome: Clinical State and Therapeutic Management
- Nephrotic syndrome includes massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
- It can occur as a primary disease known as idiopathic nephrosis, a secondary disorder, or a congenital form inherited as an autosomal recessive disorder.
- The onset of minimal-change nephrotic syndrome (MCNS) predominantly occurs in children between 2 and 7 years of age, with a rare occurrence in children younger than 6 months and after the age of 8 years.
- The pathogenesis of MCNS is not fully understood, but it may involve a disturbance causing the basement membrane of the glomeruli to become permeable to protein.
- Clinical manifestations of MCNS include generalized edema, proteinuria, hypoalbuminemia, hypercholesterolemia, and absence of hematuria and hypertension in children between 2 and 8 years of age.
- Diagnostic evaluation of MCNS is based on history, clinical manifestations, and laboratory findings, including massive proteinuria, low serum albumin, and elevated plasma lipids.
- Therapeutic management of MCNS aims to reduce urinary protein excretion, fluid retention, prevent infections, and minimize therapy-related complications.
- Dietary restrictions may include a low-salt diet and fluid restriction, with diuretic therapy or infusions of 25% albumin used in severe cases.
- Corticosteroids are the first line of therapy for MCNS, with most children responding within 7 to 21 days.
- About two thirds of children with MCNS experience relapses, which can be diagnosed early through routine home monitoring of urine protein by dipstick.
- Relapses are treated with a repeated course of high-dose steroid therapy, but adverse effects of the steroids include weight gain, behavior changes, and increased appetite.
- If the patient does not respond to a 4- to 8-week course of steroids, a renal biopsy may be needed to distinguish between other types of nephrotic syndrome.
Pediatric Renal Disorders: HUS and Wilms Tumour
- Hemolytic uremic syndrome (HUS) primarily affects infants and small children aged 6 months to 5 years and is a common cause of acquired acute kidney injury (AKI) in children.
- HUS is associated with acquired hemolytic anemia, thrombocytopenia, renal injury, and central nervous system symptoms, and can be caused by bacterial toxins, chemicals, and viruses, including E. coli, pneumococci, shigellae, and salmonellae.
- The disease is often linked to undercooked meat, unpasteurized milk or fruit juice, and sewage-contaminated water.
- The primary site of injury in HUS is the endothelial lining of the small glomerular arterioles, leading to intravascular coagulation, acute hemolytic anemia, and thrombocytopenia.
- Diagnostic evaluation of HUS involves anemia, thrombocytopenia, renal failure, proteinuria, hematuria, elevated BUN and serum creatinine levels, and a high reticulocyte count.
- Therapeutic management of HUS includes early diagnosis, aggressive supportive care, hemodialysis or peritoneal dialysis, pharmacological agents, fresh frozen plasma, plasmapheresis, and blood transfusions for severe anemia.
- The recovery rate for HUS with prompt treatment is about 95%, but residual renal impairment ranges from 10 to 50%, with long-term complications such as chronic kidney disease (CKD), hypertension, and central nervous system disorders.
- Nursing care for HUS is similar to that provided for AKI, and parents often require support and understanding due to the sudden and life-threatening nature of the disorder.
- Wilms tumour (WT) is the most common malignant renal and intra-abdominal tumor of childhood, with an estimated frequency of 7 cases per million children younger than 15 years.
- Approximately 75% of WT cases occur in children younger than 5 years, with a peak incidence at 2 to 3 years of age, and 2% of cases have a familial origin.
- Between 2012 and 2016, there were 170 cases of kidney and renal pelvis cancer diagnosed in Canadian children 0 to 14 years of age, with almost all being WT cases, and there were 11 deaths from WTs in children 0 to 14 years of age from 2013 to 2017.
- There is currently no method of identifying gene carriers of WT.
Acute Poststreptococcal Glomerulonephritis: Pathophysiology, Diagnosis, and Management
- APSGN pathophysiology involves immune complex deposition in the glomerular basement membrane, leading to edema and leukocyte infiltration, resulting in circulatory congestion and edema.
- The onset of nephritis occurs about 1 to 3 weeks after streptococcal infection, with mild symptoms initially, making association challenging for parents.
- Diagnostic evaluation includes urinalysis showing hematuria and proteinuria, elevated urea and creatinine levels, and reduced serum complement (C3) activity.
- Serological tests such as antistreptolysin O (ASO) and other antibodies aid in diagnosis, and rising C3 levels indicate disease improvement.
- Chest X-ray may show cardiac enlargement, pulmonary congestion, or pleural effusion, while renal biopsy is rarely required for diagnosis.
- Therapeutic management involves general supportive measures, hospitalization for children with complications, and dietary restrictions based on disease severity.
- Children with APSGN may develop acute kidney injury (AKI) and require careful therapeutic management, with rare need for peritoneal dialysis or hemodialysis.
- Early identification and control of acute hypertension is crucial, with regular blood pressure measurements and use of antihypertensive medications and diuretics.
- Antibiotic therapy is indicated to prevent transmission of nephritogenic streptococci to family members.
- Prognosis for APSGN is generally good, with almost all children recovering completely, developing specific immunity, and experiencing uncommon recurrences.
- Nursing care involves regular monitoring of vital signs, fluid balance, and behavior, as well as careful assessment for signs of complications and dehydration.
- Assessment of the child's appearance for signs of cerebral complications is crucial due to the variable and unpredictable severity of the acute phase.
Pediatric End-Stage Renal Disease (ESRD) and Treatment Complications
- Complications of ESRD are treated symptomatically with medications such as antiemetics, antiepileptics, and diphenhydramine.
- ESRD in children results in death within a few weeks unless treated with dialysis or kidney transplantation.
- Dialysis and transplantation are the only current treatments for ESRD in children.
- Complications of dialysis include infection, growth failure, and disruption of socialization.
- Post-transplantation complications include infection, hypertension, steroid toxicity, hyperlipidemia, aseptic necrosis, malignancy, and growth restriction.
- Primary or pre-emptive kidney transplants are becoming the optimal form of renal replacement therapy, leading to substantial improvement in quality of life.
- Nursing care for ESRD in children follows evidence-informed clinical practice guidelines.
- The disease places significant stresses on the child and family, including painful procedures, adverse effects, and frequent hospitalizations.
- Children and parents can experience depression, anxiety, denial, and disbelief upon diagnosis of ESRD.
- Dialysis initiation is traumatic and anxiety-provoking for most children, often requiring reassurance and pain management techniques.
- Adolescents undergoing hemodialysis may experience depression or hostility, and may struggle with the control and dependence imposed by therapy.
- Home peritoneal dialysis offers a greater degree of freedom for long-term dialysis patients, with a need for an in-depth teaching program for patients and families.
Chronic Kidney Disease in Children: Complications and Management
- Complications of chronic kidney disease (CKD) in children include retention of waste products, water and sodium retention, hyperkalemia, metabolic acidosis, calcium and phosphorus disturbances, anemia, and growth disturbance
- CKD children are more susceptible to infections such as pneumonia, UTI, and septicemia
- Diagnosis of CKD is based on clinical manifestations, history of renal disease, and biochemical findings
- Laboratory tests assess renal damage, biochemical disturbances, and related physical dysfunction
- Therapeutic management in irreversible renal failure aims to promote maximum renal function, maintain fluid and electrolyte balance, treat complications, and promote an active life
- Diet regulation is crucial to reduce the quantity of materials that require renal excretion
- Dietary protein intake is limited to the reference daily intake for the child’s age to support growth and neurodevelopment
- Sodium and water are not usually limited unless there is evidence of edema or hypertension, and potassium is not usually restricted
- Dietary phosphorus is controlled through reduction of protein, milk, and soft-drink intake, and treatment with 25-OH vitamin D is used to increase calcium absorption
- Growth failure in CKD children is addressed with recombinant human growth hormone
- Dental issues are common and require regular dental care
- Anemia is corrected with recombinant human erythropoietin and iron preparations, and hypertension is managed with low-sodium diet, fluid restriction, diuretics, and antihypertensive medications
Pediatric Renal Replacement Therapy Overview
- Two types of peritoneal dialysis: continuous ambulatory and continuous cycling
- Dialysis solution instilled into peritoneal cavity through surgically implanted catheter
- Dialysis timing and frequency depend on age, fluid balancing, and solute removal needs
- Home peritoneal dialysis can be empowering for families, but nurse must monitor for burnout
- External vascular access devices include percutaneous and central catheters, prone to infection
- Hemodialysis best for children without someone able to perform peritoneal dialysis or living near a dialysis center
- Hemodialysis performed 3 times per week for 4 to 6 hours, with rapid correction of fluid and electrolyte abnormalities
- Hemodialysis can cause adverse effects like muscle cramping, headaches, nausea, and hypotension
- Children experience rapid clinical improvement with dialysis, but normal growth recovery is infrequent
- Kidney transplantation offers relatively normal life and is preferred for children with ESRD
- Wait time for kidney transplant longer for Indigenous children than non-Indigenous children
- Kidneys for transplant available from living related or cadaver donors, with potential need for retransplantation due to rejection
Test your knowledge of pediatric kidney function and dysfunction, urinary tract infections, and vesicoureteral reflux with this comprehensive quiz. Challenge yourself with questions on renal abnormalities in newborns, diagnostic tests for UTIs in children, management of febrile UTIs, and more. Ideal for nurses, healthcare professionals, and anyone interested in pediatric renal health.
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