Chapter 38: Pediatric Renal and Genitourinary Problems

Urinary tract infections represent a common concern with particular prevalence in uncircumcised infants, requiring prompt identification and treatment to prevent upper tract involvement, while asymptomatic bacteriuria necessitates screening protocols in at-risk populations. Glomerulonephritis typically manifests as an immune-mediated inflammatory response following group A streptococcal infection, presenting with characteristic cola-colored hematuria, periorbital edema, hypertension, and elevated urea and creatinine levels, with management centered on fluid and sodium restriction alongside monitoring for hypertensive complications. Nephrotic syndrome constitutes a distinct clinical entity characterized by profound proteinuria, reduced serum albumin, elevated serum lipids, and edema, requiring corticosteroid or immunosuppressive pharmacotherapy combined with diuretic therapy and judicious use of plasma expanders. Hemolytic-uremic syndrome represents an acute kidney injury emergency defined by the classic triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal dysfunction, often necessitating dialytic support and careful fluid management. Vesicoureteral reflux, an anatomical abnormality allowing retrograde urine flow, ranges from primary variants stemming from valve incompetence to secondary forms resulting from bladder outlet obstruction, managed through antimicrobial prophylaxis or surgical intervention. Additional genitourinary concerns include enuresis managed through behavioral conditioning and pharmacological agents, congenital undescended testes requiring orchiopexy, urethral meatal anomalies including epispadias and hypospadias necessitating age-appropriate surgical correction with preservation of genital tissue, and bladder exstrophy demanding immediate protective measures and staged reconstructive surgery. The chapter concludes with consideration of sexually transmitted infections in adolescent populations requiring appropriate screening and intervention.