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Alterations of Renal and Urinary Tract Function in Children
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Structural Abnormalities
Horseshoe kidney Hypospadias
Chordee Epispadias Exstrophy of the bladder
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Hypospadias
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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)
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Glomerular Disorders
Glomerulonephritis Immunoglobulin A (IgA) nephropathy Nephrotic syndrome Hemolytic uremic syndrome
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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Vesicoureteral Reflux (VUR) (cont’d)
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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
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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
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Enuresis
Theories: Organic causes Factors that increase urine production Maturational lag Genetic factors Sleep patterns Psychosocial theories