Pediatric Renal Function Tests and UTIs Quiz

Pediatric Renal Function Tests and Procedures

• Retrograde pyelography involves injecting contrast medium through a ureteral catheter to visualize pelvic calyces, ureters, and bladder, often done before surgery.
• Renal angiography visualizes the renal vascular system, especially for renal arterial stenosis, and may require anesthesia in children.
• Renal biopsy, done under anesthesia, provides histological and microscopic information about renal disorders and helps distinguish between different syndromes.
• Urodynamics is a set of tests to measure bladder functions and identify types of incontinence or urinary retention, often reserved for children with bladder dysfunction.
• Urine tests of renal function measure physical, chemical, and microscopic properties, such as volume, specific gravity, osmolality, appearance, pH, and presence of proteins, glucose, ketones, and cells.
• Urinary tract infections (UTIs) occur in 1% of boys and 1 to 3% of girls, with higher incidence in male infants, especially uncircumcised boys.
• Blood tests of renal function include urea levels, which are elevated in renal disease, with higher levels indicating more severe conditions.
• Renal function tests help in diagnosing and monitoring renal disorders in pediatric patients.
• These tests and procedures require special preparation and observation for potential reactions, especially in children.
• Nurses have specific responsibilities in conducting renal function tests, including urine collection and monitoring for potential complications.
• The tests provide valuable information about renal health, including glomerular filtration rate, proteinuria, and various markers of renal function.
• Understanding the normal ranges and deviations in urine and blood tests is essential for the accurate interpretation of pediatric renal function.

Pediatric Urinary Tract Infections: Key Points

• Urinary tract infections (UTIs) can involve the lower urinary tract (urethra and bladder) or the upper urinary tract (kidneys).
• UTIs in young infants are diagnosed using suprapubic aspiration or urethral catheterization, as bag urine samples are often inaccurate due to contamination.
• UTI diagnosis requires a sterile specimen, positive urinalysis, and a positive urine culture with specific colony-forming unit (CFU) thresholds.
• Various terms used to describe urinary tract disorders include bacteriuria, asymptomatic bacteriuria, symptomatic bacteriuria, recurrent UTI, persistent UTI, febrile UTI, cystitis, urethritis, pyelonephritis, and urosepsis.
• Escherichia coli and other Gram-negative enteric organisms are the most common uropathogens responsible for UTIs in children, originating in the gastrointestinal tract and migrating to the periurethral area.
• Anatomical and physical factors, such as the short urethra in females and the antibacterial properties of prostatic secretions in males, contribute to the increased incidence of UTIs in females.
• Risk stratification for UTI development in newborns and infants falls into three categories: females, circumcised males, and uncircumcised males, with the latter being at an increased risk, especially in the presence of urinary tract anomalies.
• Holding or infrequent voiding patterns, high postvoid residuals, and altered urine and bladder chemistry can contribute to the rapid establishment of bacteria in the urinary tract, leading to UTI symptoms.
• Increased fluid intake promotes flushing of the bladder and lowers the concentration of organisms, while diuresis enhances the antibacterial properties of the renal medulla.
• Studies in adults offer limited evidence for the value of cranberry products in promoting urinary tract health, including preventing UTIs.
• Uric acid levels in children vary by age, with infants having lower levels compared to older children and adolescents.
• Severe renal disease can lead to increased uric acid levels, while persistent UTI can occur despite antibiotic treatment.