Renal Flashcards
Etiology of UTI?
Escherichia coli most common pathogen (80% of cases)
UTI manifestations in an Infant?
- Nonspecific symptoms
- Poor feeding
- Vomiting
- Irritability
- Failure to Thrive
- Fever in some cases- may be afebrile
UTI manifestations in a Child?
- Dysuria (e.g., crying on urination or vocalized pain)
- Frequent urination (>q 2 h)
- Urgency
- Suprapubic discomfort or pressure “Tummy/belly aches”
- New onset bedwetting or incontinence
UTI diagnostic tests?
- Catherization is the preferred sample in child not potty-trained
- U-bag– not used to diagnose UTIs-easily contaminated
- Clean-catch outpatient older child
UTI treatment?
- 3rd generation Cephalosporin
- Septra-Trimethoprim-sulfamethoxazole (Bactrim)
- Sulfa allergy contraindication
- Nitrofurantoin (Macrobid)
- Amoxicillin
- Pyridium (OTC and prescribed)
- Stains urine reddish-orange (mistaken for blood)
What is Normal and Minimum Urine Output?
- Normal urine output: 1-2cc/kg/hour
- Minimum urine output = 1cc/kg/hour
What is Normal and Minimum Urine Output for a child who weighs 10kg?
- Normal urine output: 10cc-20cc per hour
- Minimal urine output per hour 10cc per hour
Etiology of Acute Poststreptococcal Glomerulonephritis?
- Caused by group A β-hemolytic streptococci (strep throat)
- Onset 14 days after infection
Pathophysiology of Acute Poststreptococcal Glomerulonephritis?
- Immune response to infection –antigen- antibody complexes collect in the glomeruli causing inflammation
- Leukocytes occlude capillary
Acute Poststreptococcal Glomerulonephritis manifestations?
Sudden onset of:
- Gross hematuria
- Proteinuria
- Oliguria (decreased urinary output)
- Edema
- Hypertension
Acute Poststreptococcal Glomerulonephritis laboratory tests?
- Urinalysis: Proteinuria and Hematuria
- Renal function: Elevated BUN and creatinine (renal insufficiency)
- C-Reactive Protein (CRP) increased indicating inflammation
- Erythrocyte Sedimentation Rate (ESR)
- Antistreptolysin O (ASO) blood test: circulating antibodies in the body in response to streptococcal infection. (4-6 weeks)
Acute Poststreptococcal Glomerulonephritis treatment?
- Diuretics (Furosemide-Lasix)
- Daily weights
- Strict I&O
- Sodium restriction if hypertension or edema present
- Monitor vital signs
Etiology of Nephrotic Syndrome?
- Nephrotic syndrome is the most common chronic glomerular injury in children
- Etiology is not completely understood: 70-80% cases from “minimal change disease” or MCD
Pathophysiology of Nephrotic Syndrome?
glomerular membrane becomes permeable to large proteins → albumin lost in urine → due to low albumin in blood, fluid shifts to interstitial spaces resulting in edema.
Nephrotic Syndrome manifesations?
- Massive proteinuria
- Hypoalbuminemia
- Hyperlipidemia
Edema: most common presentation - BP is usually normal or slightly decreased
- At risk of chronic kidney disease and end stage renal disease
- 10-20% of children will have Steroid Resistant Nephrotic Syndrome
Nephrotic Syndrome nursing considerations?
Evaluate a child who exhibits the following symptoms for the possibility of nephrotic syndrome:
- Periorbital, abdominal, gonadal, or lower extremity edema
- Weight gain greater than expected based on previous pattern
- Decreased urinary output (Fluid goes to interstitial space)
- Pallor, fatigue
Nephrotic Syndrome treatment?
- Diet
- Protein restricted if azotemia (excess nitrogen in the blood) or renal failure
- Sodium restrictions
- Protein restricted if azotemia (excess nitrogen in the blood) or renal failure
- Steroids (Prednisone)
- Immunosuppressant therapy (Cytoxan)
- Diuretics (Lasix-Furosemide)
Acute Kidney Injury (AKI) manifesations?
- **Principal feature is oliguria: urine output < 1ml/kg/hr **
- Most common cause of AKI results from severe dehydration
- Usually reversible
- Dialysis may be needed temporarily
Describe Chronic Renal Failure (CRF).
- Progressive deterioration over months to years
- Final stage (End Stage Renal Disease) is irreversible
- Treatment with dialysis and medication
- Transplant if a candidate
Chronic Renal Failure (CRF) manifestations?
- Uremia (anorexia, vomiting)
- Growth Failure
- Osteodystrophy
- bone pain, deformity (knock knees) or waddling gate, rickets
- Convulsions (Seizure)
- Hypertension, hypocalcemia
- Anemia
Renal Failure nursing considerations?
- Monitor BP
- Monitor labs (BUN/creatinine)
- Monitor growth
- Administer diuretics
- Regulation of diet most effective means 2nd to dialysis
- Low sodium, fluid restrictions initially
- Recommended Dietary Allowance (RDA) protein
- Potassium limitations if increased creatinine
Who would be a better candidate for Hemodialysis?
- Preferred dialysis method for children over 20 kg
- Best suited for children who live close to dialysis center (requires 3 visits per week for 3-5hrs
- Requires creation of a vascular access and special dialysis equipment
- Achieves rapid correction of fluid and electrolyte abnormalities
Who would be a better candidate for Peritoneal Dialysis?
- Can be managed at home-child can receive treatment while sleeping.
- Slower and gentle compared to hemodialysis
Indicated for neonates, children. - Dialysate absorbs or pulls waste and fluids from blood vessels in the abdominal lining.
Peritoneal Dialysis nursing considerations?
- Assess peritoneal insertion site for redness, edema, discharge
- Assess peritoneal fluid (if cloudy contact provider)- R/O peritonitis
- Daily weight
- Measure abdominal girth
