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Pediatric Renal Disorders
- 1. The Child with Genitourinary Dysfunction Chapter 27
- 24. So how do you find out?
- 43. Diagnosing APSG
Hinweis der Redaktion
- NB will produce 1-2 ml/kg/hr; after 1 mo. Approx 1 ml/kg/hr
- Second most common bacterial disease Account for more than 8 million office visits per year Results in >100, 000 people hospitalized annually >15% patients who develop gram-negative bacteria DIE 1/3 of gram-negative infections originate in urinary tract
- Bladder and its contents are free of bacteria in majority of healthy patients Minority of healthy individuals have colonizing bacteria in bladder Called asymptomatic bacteria and does not justify treatment
- Gram-negative bacilli from GI tract common cause Fungal generally after multiple antibiotic courses; Also more common w/ immunosuppressed or diabetics
- Cystitis—Contained in bladder Urethritis—Irritation>>infection; potential for ascending Pyelonephritis—Inflam of upper urinary tract and may involve kidneys Role of vesicoureteral reflux VUR—w/ ea void, urine goes up into ureter and is opportunity for microbial proliferation Glomerulonephritis—Immunologic disorder in the kidney proper; did not begin in the bladder and ascend; Generally follows other bacterial illness, esp strep
- Uncomplicated infection: occurs in otherwise normal urinary tract Complicated Infections: Stones Obstruction Catheters Diabetes or neurologic disease Recurrent infection
- Recurrent is reinfection in person whose prior infection was successfully eradicated Recurrent occurs because original infection not adequately eradicated Unresolved bacteriuria: bacteria resistant or drug discontinued before bacteriuria is completely eradicated Bacterial persistence: resistance developed or foreign body in urinary system serves as harbor and anchor for bacteria to survive despite therapy
- Explain what this means
- This can also occur in adults as well This is why when a child is admitted with FUO urine culture is done as part of the septic workup.
- Dipstick : to identify presence of nitrates, WBCs, and leukocyte esterase Confirm w/ micro ua Urine culture indicated in complicated or nosocomial, persistent bacteria, or frequently recurring (>2 episodes annually) May be cultured if infection is unresponsive to empiric therapy or diagnosis is questionable
- Clean-catch is preferred Specimen obtained by catheterization or suprapubic needle aspiration has more accurate results May be necessary when clean-catch cannot be obtained
- Antibiotic selected on empiric therapy or results of sensitivity testing
- Sulfa : used to treat empiric uncomplicated or initial Inexpensive TMP-SMX taken bid Pyridium is OTC that provides soothing effect on urinary tract mucosa Stains urine reddish orange that can be mistaken for blood and may stain underclothing Effective in relieving discomfort
- Suppressive therapy often effective on short-term basis Limited because of antibiotic resistance ultimately leading to breakthrough infections
- Obstruction from BPH or from stone Stricture (narrowing)
- Vary from mild fatigue to sudden onset of chills, fever, vomiting, malaise, flank pain, and lower urinary tract symptoms characteristic of cystitis Costovertebral tenderness usually present on affected side, kidney usually palpated as enlarged Acute Pyelonephritis Nausea, vomiting, anorexia, chills, nocturia, frequency, urgency Suprapubic or lower back pain, bladder spasms, dysuria, burning on urination Fever, Hematuria, foul-smelling urine, tender, enlarged kidney Leukocytosis, positive findings for bacteria, WBCs, RBCs, pyuria,
- Urinalysis shows pyuria, bacteriuria, and varying degrees of hematuria WBC casts indicate involvement of renal parenchyma CBC will show leukocytosis with increase in immature bands If bacteremia is a possibility, close observation and vitals monitoring are essential Prompt recognition and treatment of septic shock may prevent irreversible damage or death
- Hospitalization for patients with severe infections and complications such as nausea and vomiting with dehydration Parenteral antibiotics to establish high serum levels
- Diagnostics: UA, CBC, BUN, Serum creatinine, and albumin Complement levels and ASO Titer Renal Bx prn
- Most kids will normally restrict activity due to malaise
- MCNS is most common of these Pathogenesis not known
- Prognosis is usually good for ultimate recovery in most cases (80%) Self limiting If child responds to steroids, usually will do ok Early detection and treatment to decrease proteinuria, and permanent renal damage About 20% will have relapses for up to 5 yrs, some up to 10 yrs.