Chapter 44: The Child With a Genitourinary Alteration

Although infants are born with a full nephron population, their kidneys require approximately two years to achieve adult-level filtration and concentration capabilities, leaving them more susceptible to fluid imbalances and physiological stress during this critical period. The chapter establishes foundational assessment approaches through urinalysis evaluation of specific gravity and proteinuria alongside serum markers including blood urea nitrogen and creatinine levels, supplemented by advanced imaging modalities such as voiding cystourethrogram to identify vesicoureteral reflux. Functional disorders receive detailed coverage, particularly enuresis, which is classified as primary or secondary with management strategies encompassing behavioral interventions and pharmacological options. Urinary tract infections represent a significant concern in pediatric populations, with females experiencing higher prevalence due to anatomical variations and increased risk of ascending infection leading to vesicoureteral reflux and consequent renal scarring if untreated. Structural anomalies including hypospadias, epispadias, and cryptorchidism require surgical intervention to preserve normal urinary and reproductive function alongside psychosocial outcomes. The chapter contrasts glomerular pathologies such as acute poststreptococcal glomerulonephritis with nephrotic syndrome, highlighting their distinct inflammatory mechanisms and protein metabolism patterns. Progression toward renal dysfunction is examined through acute kidney injury, often triggered by hemolytic uremic syndrome, which may advance to chronic kidney disease and eventually end-stage renal disease. Management of advanced renal failure incorporates hemodialysis and peritoneal dialysis modalities alongside kidney transplantation considerations, all requiring comprehensive multidisciplinary family-centered care throughout treatment journeys.