Chapter 26: Genitourinary Dysfunction in Children

Genitourinary Dysfunction in Children begins with the assessment of urinary tract integrity, emphasizing the importance of physical examination, history taking, and diagnostic tools such as urinalysis, renal ultrasound, and voiding cystourethrography to evaluate kidney structure and function. A significant portion of the discussion focuses on urinary tract infections, identifying Escherichia coli as the primary pathogen, and explores contributing factors like urinary stasis and anatomic defects. The text details the management of vesicoureteral reflux, noting the risks of pyelonephritis and renal scarring, alongside the controversy surrounding antibiotic prophylaxis versus surgical intervention. Structural defects are thoroughly analyzed, including obstructive uropathy, phimosis, hydrocele, cryptorchidism requiring orchiopexy, and hypospadias, where surgical correction aims to restore function and appearance. Severe anomalies like the exstrophy-epispadias complex and disorders of sex development are addressed with a focus on reconstructive surgery and psychosocial support. The chapter differentiates between key glomerular conditions: nephrotic syndrome, characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema managed primarily with corticosteroids; and acute glomerulonephritis, often a postinfectious immune-complex disease presenting with oliguria, hypertension, and hematuria. Hemolytic uremic syndrome is described as a triad of anemia, thrombocytopenia, and renal failure, frequently associated with bacterial toxins. Finally, the text covers the spectrum of renal failure, from reversible acute kidney injury marked by oliguria and metabolic acidosis to chronic kidney disease which leads to uremia and complications such as renal osteodystrophy and anemia. Management strategies for end-stage renal disease are outlined, including dietary regulation, pharmacologic support, dialysis modalities like hemodialysis and peritoneal dialysis, and kidney transplantation as the preferred long-term treatment.