elsevier items and derived items © 2008 by mosby, inc., an affiliate of elsevier inc. some material...

Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Some material was previously published.

Alterations of Renal and Urinary Alterations of Renal and Urinary Tract Function in ChildrenTract Function in Children

Chapter 30Chapter 30


Structural AbnormalitiesStructural Abnormalities

Horseshoe kidneyHorseshoe kidney HypospadiasHypospadias

ChordeeChordee EpispadiasEpispadias Exstrophy of the bladderExstrophy of the bladder


HypospadiasHypospadias


Structural AbnormalitiesStructural Abnormalities

Bladder outlet obstructionBladder outlet obstruction Ureteropelvic junction obstruction (UPJ)Ureteropelvic junction obstruction (UPJ)

Secondary UPJSecondary UPJ Hypoplastic or dysplastic kidneysHypoplastic or dysplastic kidneys

Renal aplasia or dysplasiaRenal aplasia or dysplasia Polycystic kidney diseasePolycystic kidney disease Renal agenesisRenal agenesis

Unilateral or bilateral (Potter syndrome)Unilateral or bilateral (Potter syndrome)


Glomerular DisordersGlomerular Disorders

GlomerulonephritisGlomerulonephritis Immunoglobulin A (IgA) nephropathyImmunoglobulin A (IgA) nephropathy Nephrotic syndromeNephrotic syndrome Hemolytic uremic syndromeHemolytic uremic syndrome


GlomerulonephritisGlomerulonephritis

Acute poststreptococcal Acute poststreptococcal glomerulonephritisglomerulonephritis Occurs after a throat or skin infection with Occurs after a throat or skin infection with

certain strains of group A alpha-hemolytic certain strains of group A alpha-hemolytic streptococcistreptococci

Experience a sudden onset of hematuria, Experience a sudden onset of hematuria, edema, hypertension, and renal insufficiencyedema, hypertension, and renal insufficiency



Acute poststreptococcal Acute poststreptococcal glomerulonephritisglomerulonephritis Antigen-antibody complexes and complement Antigen-antibody complexes and complement

are deposited in the glomerulusare deposited in the glomerulus The immune complexes initiate inflammation The immune complexes initiate inflammation

and glomerular injuryand glomerular injury



Immunoglobulin A (IgA) nephropathyImmunoglobulin A (IgA) nephropathy IgA nephropathy is characterized by the IgA nephropathy is characterized by the

deposition of mostly IgA but some IgM deposition of mostly IgA but some IgM antibodies and complement in the mesangium antibodies and complement in the mesangium of the glomerular capillariesof the glomerular capillaries



Henoch-Schönlein purpura nephritisHenoch-Schönlein purpura nephritis Also referred to as anaphylactoid purpuraAlso referred to as anaphylactoid purpura IgA nephropathy that causes inflammation and IgA nephropathy that causes inflammation and

damage to the glomerular blood vesselsdamage to the glomerular blood vessels


Nephrotic SyndromeNephrotic Syndrome

Nephrotic syndrome is a symptom complex Nephrotic syndrome is a symptom complex related to loss of protein in the urinerelated to loss of protein in the urine Minimal change nephropathy (MCN)Minimal change nephropathy (MCN) Focal segmental glomerulosclerosis (FSGS)Focal segmental glomerulosclerosis (FSGS) Congenital nephrotic syndromeCongenital nephrotic syndrome

Nephrotic syndrome can be primary or Nephrotic syndrome can be primary or secondary in relation to causesecondary in relation to cause


Hemolytic-Uremic Syndrome Hemolytic-Uremic Syndrome (HUS)(HUS)

HUS is the most common cause of acute HUS is the most common cause of acute renal failure in childrenrenal failure in children

There is an association of HUS with There is an association of HUS with bacterial and viral agentsbacterial and viral agents Escherichia coliEscherichia coli 0157:H7 0157:H7



The bacterial toxin from The bacterial toxin from E. coliE. coli damages damages red cells and endothelial cellsred cells and endothelial cells

The endothelial lining of the glomerulus The endothelial lining of the glomerulus becomes swollen and occluded with fibrin becomes swollen and occluded with fibrin clotsclots



The damaged red cells are removed from The damaged red cells are removed from the circulation by the spleen, causing the circulation by the spleen, causing acute hemolytic anemiaacute hemolytic anemia

The microcirculation develops numerous The microcirculation develops numerous thrombithrombi


Urinary Tract Infections (UTIs)Urinary Tract Infections (UTIs)

UTIs are common 7- to 11-year-old girlsUTIs are common 7- to 11-year-old girls E. coli,E. coli, the most common pathogen, the most common pathogen,

ascends the urethra in cystitis or the ureter ascends the urethra in cystitis or the ureter in pyelonephritis in pyelonephritis

CystitisCystitis Acute and chronic pyelonephritis Acute and chronic pyelonephritis


Vesicoureteral Reflux (VUR)Vesicoureteral Reflux (VUR)

Retrograde flow of urine from the bladder Retrograde flow of urine from the bladder into the uretersinto the ureters

Reflux encourages infected urine from the Reflux encourages infected urine from the bladder to be swept up into the kidneysbladder to be swept up into the kidneys

Leads to frequent pyelonephritisLeads to frequent pyelonephritis



Caused by a congenital abnormality or Caused by a congenital abnormality or ectopic insertion of the ureter into the ectopic insertion of the ureter into the bladderbladder

Diagnosed by a voiding cystourethrogram Diagnosed by a voiding cystourethrogram (VCUG) and an intravenous pyelogram (VCUG) and an intravenous pyelogram (IVP)(IVP)


Wilms TumorWilms Tumor

Wilms tumor is an embryonal tumor of the Wilms tumor is an embryonal tumor of the kidney kidney

Wilms tumor arises from the proliferation Wilms tumor arises from the proliferation of abnormal renal stem cells of abnormal renal stem cells

Inherited and sporadic formsInherited and sporadic forms Usually found by parent due to abdominal Usually found by parent due to abdominal

swellingswelling


EnuresisEnuresis

Involuntary passage of urine by a child Involuntary passage of urine by a child who is beyond the age (4 to 5 years old) who is beyond the age (4 to 5 years old) when voluntary bladder control should when voluntary bladder control should have been acquiredhave been acquired

Primary enuresisPrimary enuresis The child has never been continentThe child has never been continent

Secondary enuresisSecondary enuresis Diurnal, nocturnal, or bothDiurnal, nocturnal, or both


EnuresisEnuresis

TheoriesTheories Organic causesOrganic causes Maturational lagMaturational lag Genetic factorsGenetic factors Sleep patternsSleep patterns Psychosocial theoriesPsychosocial theories

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