Alterations of Renal and Urinary Tract Function in Children

1. Alterations of Renal and Urinary Tract Function in Children Chapter 30

2. Structural Abnormalities • Horseshoe kidney • Hypospadias • Chordee • Epispadias • Exstrophy of the bladder

3. Hypospadias

4. 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)

5. Glomerular Disorders • Glomerulonephritis • Immunoglobulin A (IgA) nephropathy • Nephrotic syndrome • Hemolytic uremic syndrome

6. 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

7. Glomerulonephritis • Acute poststreptococcal glomerulonephritis • Antigen-antibody complexes and complement are deposited in the glomerulus • The immune complexes initiate inflammation and glomerular injury

8. Glomerulonephritis • 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

9. Glomerulonephritis • Henoch-Schönlein purpura nephritis • Also referred to as anaphylactoid purpura • IgA nephropathy that causes inflammation and damage to the glomerular blood vessels

10. 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

11. Hemolytic-Uremic Syndrome (HUS) • 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 0157:H7

12. Hemolytic-Uremic Syndrome (HUS) • 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

13. Hemolytic-Uremic Syndrome (HUS) • The damaged red cells are removed from the circulation by the spleen, causing acute hemolytic anemia • The microcirculation develops numerous thrombi

14. 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

15. 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

16. Vesicoureteral Reflux (VUR) • 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)

17. Vesicoureteral Reflux (VUR)

18. 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

19. 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 • Diurnal, nocturnal, or both

20. Enuresis • Theories • Organic causes • Maturational lag • Genetic factors • Sleep patterns • Psychosocial theories