Week 4.3 - Renal/GU Flashcards
How does the kidney differ in infants?
Number of nephrons is small, and GFR and absorption is lower
–> Inability to concentrate urine because loop of Henle is shorter
–> Urea synthesis and excretion are lower
At what point do children have mature kidneys?
1 year
When does enuresis usually stop?
4-5 years of age
What is the most common pathogen that causes UTI in children?
E. Coli
What is the most common serious bacterial infection in infants and children?
UTI
Why might a child not be able to completely empty their bladder? What might this lead to?
Constipation –> UTI
What are the physiological defense mechanisms to maintain urine sterility?
Empty bladder completely
Normal antibacterial properties of urine and tract
Uterovesical junction competence
Peristaltic activity
But colonization of the urethral area can occur and can ascend to the bladder
What is vesicourethral reflux?
Allows urine to flow back into the ureters and kidneys
–> Risk for UTI
Why are seizures sometimes seen in UTI of neonates?
seizures can occur d/t uncontrolled fever
What are the different grades of vesicoureteral reflux?
Grade I - urine reflux into nondilated ureter
Grade II - urine reflux into the
ureter & renal pelvis, without
swelling of the top of the ureter
(hydronephrosis)
Grade III - reflux into the ureter,
renal pelvis, causing moderate
hydronephrosis
Grade IV - moderate
hydronephrosis
Grade V – Gross dilatation of
ureter, pelvis, etc, results in
severe hydronephrosis &
twisting of the ureter
How to prevent bacteria from reaching kidneys in vesicoureteral reflux?
Long term antibiotics to keep urine sterile
What is the most common cause of renal scarring in children?
Vesicoureteral reflux + UTIs
When is conservative treatment indicated for vesicourethral reflux? What does this entail?
Mainly for grades 1, 2, 3
–> Long-term antibiotics
–> 2-3 monthly urine cultures
–> Good hygiene / void after sex
When is surgical treatment indicated for vesicourethral reflux?
When there are significant anatomic abnormalities, severe VUR, or recurrent UTIs/antibiotic intolerance
–> Also poor compliance
–> VUR after puberty in females
What medications are often used to treat UTIs?
Commonly effective medications are the penicillins and sulfonamides
–> But a culture and sensitivity should be conducted
What can result from untreated obstructive uropathy?
dilation of urinary tract, metabolic acidosis and inability to concentrate urine.
