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Alterations of Renal and Urinary
Tract Function in Children

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Structural Abnormalities
 Horseshoe kidney
 Hypospadias
 Chordee
 Epispadias
 Exstrophy of the bladder

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Hypospadias

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Structural Abnormalities
 Bladder outlet obstruction
 Ureteropelvic junction obstruction (UPJ)
 Secondary UPJ
 Hypoplastic or dysplastic kidneys
 Renal aplasia or dysplasia
 Polycystic kidney disease
 Renal agenesis
 Unilateral or bilateral (Potter syndrome)

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Glomerular Disorders
 Glomerulonephritis
 Immunoglobulin A (IgA) nephropathy
 Nephrotic syndrome
 Hemolytic uremic syndrome

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Glomerulonephritis
 Acute poststreptococcal
glomerulonephritis
 Occurs after a throat or skin infection with
certain strains of group A alpha-hemolytic
streptococci
 Experience a sudden onset of hematuria,
edema, hypertension, and renal insufficiency

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Glomerulonephritis (cont’d)
 Acute poststreptococcal
glomerulonephritis (cont’d)
 Antigen-antibody complexes and complement
are deposited in the glomerulus
 The immune complexes initiate inflammation
and glomerular injury

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Glomerulonephritis (cont’d)
 Immunoglobulin A (IgA) nephropathy
 IgA nephropathy is characterized by the
deposition of mostly IgA but some IgM
antibodies and complement in the mesangium
of the glomerular capillaries

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Glomerulonephritis (cont’d)
 Henoch-Schönlein purpura nephritis
 Also referred to as anaphylactoid purpura
 IgA nephropathy that causes inflammation and
damage to the glomerular blood vessels

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Nephrotic Syndrome
 Nephrotic syndrome is a symptom
complex related to loss of protein in the
urine
 Minimal change nephropathy (MCN)
 Focal segmental glomerulosclerosis (FSGS)
 Congenital nephrotic syndrome
 Nephrotic syndrome can be primary or
secondary in relation to cause

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Hemolytic-Uremic Syndrome
(HUS)
 Characterized by hemolytic anemia,
thrombocytopenia, acute renal failure
 HUS is the most common cause of acute
renal failure in children
 There is an association of HUS with
bacterial and viral agents
 Escherichia coli

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Hemolytic-Uremic Syndrome
(HUS) (cont’d)
 The bacterial toxin from E. coli damages
red cells and endothelial cells
 The endothelial lining of the glomerulus
becomes swollen and occluded with fibrin
clots

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Hemolytic-Uremic Syndrome
(HUS) (cont’d)
 The damaged red cells are removed from
the circulation by the spleen, causing
acute hemolytic anemia
 The microcirculation develops numerous
thrombi

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Hemolytic-Uremic Syndrome
(HUS) (cont’d)
 Manifestations:
 Sudden onset of pallor, bruising or purpura,
irritability, and oliguria
 Slight fever, anorexia, vomiting, diarrhea (with
the stool characteristically watery and blood
stained), abdominal pain, mild jaundice, and
circulatory overload

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Hemolytic-Uremic Syndrome
(HUS) (cont’d)
 Seizures and lethargy indicate CNS
involvement
 Renal failure is apparent within the first
days of onset, causing metabolic acidosis,
azotemia, hyperkalemia, hypertension

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Urinary Tract Infections (UTIs)
 UTIs are common 7- to 11-year-old girls
 E. coli, the most common pathogen,
ascends the urethra in cystitis or the ureter
in pyelonephritis
 Cystitis
 Acute and chronic pyelonephritis

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Vesicoureteral Reflux (VUR)
 Retrograde flow of urine from the bladder
into the ureters
 Reflux encourages infected urine from the
bladder to be swept up into the kidneys
 Leads to frequent pyelonephritis

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Vesicoureteral Reflux (VUR)
(cont’d)
 Caused by a congenital abnormality or
ectopic insertion of the ureter into the
bladder
 Diagnosed by a voiding cystourethrogram
(VCUG) and an intravenous pyelogram
(IVP)

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Vesicoureteral Reflux (VUR)
(cont’d)

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Nephroblastoma/Wilms Tumor
 Wilms tumor is an embryonal tumor of the
kidney
 Wilms tumor arises from the proliferation
of abnormal renal stem cells
 Inherited and sporadic forms
 Usually found by parent due to abdominal
swelling

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Incontinence/Enuresis
 Involuntary passage of urine by a child
who is beyond the age (4 to 5 years old)
when voluntary bladder control should
have been acquired
 Primary enuresis
 The child has never been continent
 Secondary enuresis
 Daytime enuresis
 Nighttime enuresis

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Enuresis
 Theories:
 Organic causes
 Factors that increase urine production
 Maturational lag
 Genetic factors
 Sleep patterns
 Psychosocial theories