Chapter 46: Renal & Urinary Disorders in Children Nursing Care

The discussion contextualizes the physical and psychosocial changes experienced by children with these disorders, emphasizing the importance of recognizing vague symptoms like mild abdominal pain or low-grade fever that may indicate serious illness. The text highlights specific Healthy People 2030 objectives related to pediatric renal health, such as reducing the prevalence of chronic kidney disease in adolescents and decreasing the incidence of end-stage kidney disease (ESKD). Assessment requires careful attention to history, physical examination findings (including edema, hypertension, and pale mucous membranes), and diagnostic procedures. Key diagnostic tools detailed include urinalysis, urine culture, blood urea nitrogen (BUN) and creatinine studies, and various imaging techniques such as magnetic resonance imaging (MRI), intravenous pyelogram (IVP), and voiding cystourethrogram (VCUG); specific preparation for tests, such as addressing a child's discomfort with voiding in public during a VCUG, is essential. For renal failure, the chapter examines renal replacement therapies, differentiating between peritoneal dialysis (PD), which utilizes the abdominal membrane, and hemodialysis, which employs an external filtering coil, noting the advantages of Continuous Cycling Peritoneal Dialysis (CCPD) for increasing a child's freedom. Structural abnormalities covered include patent urachus; exstrophy of the bladder, a severe midline closure defect requiring specialized staged surgical repair; and urethral opening defects like hypospadias and epispadias. A significant portion of the material addresses infections, particularly Urinary Tract Infections (UTIs), stressing prevention methods like proper perineal hygiene and advocating for a full course of antibiotics, while cautioning against recurrent UTIs which may indicate an underlying anomaly like vesicoureteral reflux (VUR). Glomerular disorders are detailed, including acute poststreptococcal glomerulonephritis (APSGN), which is generally self-limiting but causes hematuria and hypertension, and nephrotic syndrome (nephrosis), an immunologic process resulting in massive proteinuria, low serum albumin, edema, and hyperlipidemia, typically requiring corticosteroid therapy. The chapter concludes by reviewing the progressive nature of chronic kidney disease, which leads to complications like renal rickets (osteodystrophy) and anemia, culminating in ESKD, where kidney transplantation becomes the primary long-term option, requiring careful donor matching via Human Leukocyte Antigen (HLA) typing and continuous immunosuppressive medication to mitigate rejection risk.