Chapter 45: Genitourinary Dysfunction in Children

Evaluation begins with a comprehensive physical assessment and history, supported by vital diagnostic tools like urinalysis—the most significant laboratory test—as well as radiologic imaging such as voiding cystourethrography and renal biopsies. A primary nursing priority involves monitoring fluid intake and output, blood pressure, and creatinine clearance to assess the glomerular filtration rate, which signifies the efficiency of plasma filtration. Urinary tract infections (UTIs) are a major focus, categorized into lower tract irritations like cystitis or upper tract involvements such as pyelonephritis, which carries a risk of permanent renal scarring. Factors contributing to UTIs include urinary stasis, anatomical differences, and conditions like vesicoureteral reflux (VUR), where urine flows backward toward the kidneys. The text details structural abnormalities including obstructive uropathy, which can lead to hydronephrosis, and various external defects such as hypospadias, cryptorchidism, and bladder exstrophy. Special attention is given to disorders of sex development (DSD) and the emergency management of congenital adrenal hyperplasia to prevent life-threatening electrolyte shifts. Glomerular diseases are heavily explored, contrasting the massive proteinuria and edema found in nephrotic syndrome—primarily treated with corticosteroids—against the tea-colored hematuria and hypertension characteristic of acute poststreptococcal glomerulonephritis. Additionally, the chapter covers hemolytic uremic syndrome, a frequent cause of acquired renal failure typically linked to bacterial toxins. Acute kidney injury (AKI) is characterized by a sudden drop in urinary output and the dangerous accumulation of potassium, requiring immediate intervention to prevent cardiac arrest. In contrast, chronic kidney disease (CKD) involves a progressive decline in renal function over time, leading to uremic syndrome, stunted growth, and anemia due to diminished erythropoietin production. For end-stage cases, the text outlines technological management through peritoneal dialysis, hemodialysis, and the long-term goal of kidney transplantation, emphasizing the continuous need for psychological and educational support for both the child and family as they navigate these chronic conditions.