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Family will monitor BP, weight, protein in urine and relapseoGlomerulonephritis:Group of diseases that result in inflammation of the glomeruli and may result in altered kidney functionAcute Post-Streptococcal Glomerulonephritis:Result of infection with group A beta-hemolytic strepCommonly seen in ages 2 – 7 yearsS/S:Ill-appearingAnorexia IrritabilityLethargyCloudy, tea-colored urineDecreased urine outputMild-to-severe hypotensionFacial edema (spreads to extremities throughout the day)Labs:Throat culture (usually VE)UARenal Function (elevated BUN and creatinine levels)+ASO titerDecreased serum complement (C3), rising as disease is improvingTx:Diuretics & Anti-hypertensivesNursing Care:Monitor I&OsDaily weightsNeuro status (monitor for seizures)oEsp. children who have facial edema, HTN and gross hematuriaPossible Na/Fluid restrictionLow K dietSmall frequent mealsoNephrotic Syndrome:Acute Glomerulonephritis
GU Alterations in PediatricsProfound proteinuriaProteinuria Hypoalbuminia Normal albumin Severe edema Edema (Na & fluid retention)Normal blood pressureHypertensionIncreased risk of infectionHematuriaoHemolytic Uremic Syndrome (HUS)Pathophysiology:One of the most frequent causes of acquired acute renal failure in childrenAcquired hemolytic anemia, thrombocytopenia, renal injury, CNS symptomsThought to be associated with bacterial toxins, chemical, and virusesoE. coli – undercooked meat, unpasteurized juice/milk, lettuceGI illness sudden onset of hemolysis and renal failureS/S:VomitingIrritabilityLethargyPallorOliguria/anuriaCNS involvement (seizures, stupor, coma)Signs of HF (less common)Hemorrhage manifestations (bruising, petechia, jaundice, bloody diarrhea)Dx:Triad: anemia, thrombocytopenia, and renal failurePrognosis:95% recovery but 10 – 50% have renal impairmentTx:Symptomatic medicationPlasma pheresisDialysisoWilm’s tumorTested in oncology contentTumor in kidneyDon’t palpate the abdomenAcute Renal Failure:
GU Alterations in PediatricsoSudden inability of the kidneys to regulate the volume and composition of urine appropriatelyoPrinciple feature: oliguria, azotemia, metabolic acidosis, electrolyte disturbancesoCauses:Multiple pathologic conditionsRenal injuryPoor renal perfusion (heart failure)Urinary tract obstructionoMost common in children:Severe dehydration or other causes of poor perfusion severe reduction in GFR,elevated BUN, reduction in renal blood flowoUsually reversibleoS/S:Oliguria/anuriaNauseaVomiting DrowsinessEdemaHTNoDx:BUN, creatinine, pH, sodium, potassium, calciumUsually caused by underlying disease process; if not then investigate for exposure to nephrotoxic chemicals (solvents, medications/drugs)oTx:Treat the underlying causeManagement of complicationsSupportive therapy (IV fluids – careful not to overhydrate hyponatremia)oComplications:HyperkalemiaHTNAnemiaSeizures