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Nephrotic Syndrome
WITH
GENITOURINARY 1. GENITOURINARY A. Urinary Tract Infection
DYSFUNCTION 2. CNS
3. MUSCULOSKELETAL B. Acute Glomerulonephritis
4. ENDOCRINE
5. INTEGUMENTARY
C. Interstitial Nephritis
D. Renal Transplant
A. Signs and Symptoms of Urinary tract
Assessment and Disorders in
Neonatal period
Assessment:
Infancy
Physical examination
Childhood History taking
Radiology
B. Physical test
Clinical Manifestation:
C. Chemical test
The incidence and type of kidney or urinary tract
D. Microscopic test
dysfunction changes w/ the age and maturation of the
E. Radiologic and other test of the child.
urinary system function
Eg. Enuresis has greater significance at age 8 than at
F. Blood test of the renal function age 4.
ACUTE RENAL FAILURE CRF begins when the diseased kidneys can no
longer the normal chemical structure of body fluids under
ARF is said to exist when the kidneys suddenly are normal conditions. Progressive deterioration over months or
unable to regulate the volume and composition of urine years produces a variety of clinical and biochemical
appropriately in response to food and fluid intake and the disturbances that eventually culminate in the clinical syndrome
needs of the organism. The principal features of ARF is known as uremia.
oliguria. ARF is not common in childhood, but the outcome
depends on the cause, associated findings, and prompt Pathophysiology:
recognition and treatment. The most common cause in
children is transient renal failure resulting from severe Early in the progressive nephrotic destruction, the
dehydration. child remains asymptomatic with only minimal biochemical
abnormalities. Midway in the disease process, as increasing
Pathophysiology: numbers of nephrons are totally destroyed and most others are
damaged to varying degrees, the few that remain intact are
ARF is usually reversible, but the deviations of hypertrophied but functional. As the disease progresses to the
physiologic function can be extreme, and mortality in the end stage, because of severe reduction in the number of
pediatric age group remains high. There is severe reduction in functioning nephrons, the kidneys are no longer able to
the glomelular filtration rate, an elevated blood urea nitrogen maintain fluid and electrolyte balance, and the features of
level, and a significant reduction in renal blood flow. uremic symdrome appear. Children with CRF seem to be more
susceptible to infection, especially pneumonia, urinary tract
Diagnostic Evaluation: infection, and septicemia, although the reason for this is
unclear.
When a previously well child develops ARF without
obvious cause, a careful history is taken to reveal symptoms Diagnostic Evaluation:
that may be related to glomerulonephritis, obstructive uropathy,
or exposure to nephrotoxic chemicals. Significant laboratory Laboratory and other diagnostic tools and tests are of
measurements during renal shutdown that serve as a guide for value in assessing the extent of renal damage, biochemical
therapy are blood uera nitrogen, serum creatinine, pH, sodium, disturbances, and related physical dysfunction. Because the
potassium, and calcium. onset is usually gradual, and the initial signs and symptoms
are vague and nonspecific.
Therapeutic Management:
Therapeutic Management: History of phryngitis or tonsiltis 2 to 3 weeks before
symptoms
In irreversible renal failure the goals of medical management
are to: Types:
Other signs and symptoms: Periorbital and facial edema that is more prominent in
the morning
Weight loss Anorexia
Facial edema Decreased urinary output
Malaise Cloudy, smoky, brown-colored urine
Bone or joint pain Pallor, irritability, lethargy
Growth retardation In the older child, headaches, abdominal or flank pain,
Dryness or itching in the skin dysuria
Bruised skin Hypertension
Sensory or motor loss Proteinuria that produces a persistent and excessive
Amenorrhea foam in the urine
Uremic syndrome (untreated) Azotemia
Gastrointestinal symptoms Increased blood urea nitrogen and creatinine levels
Anorexia Increased antistreptolysin O titer (used to diagnose
Nausea and vomiting disorders caused by streptococcal infections)
Bleeding tendencies
1. Bruises Interventions:
2. Bloody diarrheal stools
Monitor vital signs, weight, intake and output, and the
3. Stomatitis
characteristics of urine.
4. Bleeding from lips and mouth
Limit activity, provide safety measures.
SUPPLEMENT Nutrition
o Restrictions depend on the stage and severity of the
Glomerulonephritis (Acute Poststreptococcal disease, especially the extent of the edema.
Glomerulonephritis) o In uncomplicated cases, a regular diet is permitted but
sodium is restricted to a no added salt to foods diet.
Glomerulonephritis is a term that includes a variety of o Moderate sodium restriction is prescribed for the child
disorders, most of which are caused by an with hypertension or edema.
immunological reaction. o Foods high in potassium are restricted during periods
The disorder results in proliferative and inflammatory of oliguria.
changes within the glomerular structure. o Protein is restricted if the child has severe azotemia
Destruction, inflammation, and sclerosis of the
resulting from prolonged oliguria.
glomeruli of both kidneys occur.
Monitor for complications (renal failure, hypertensive
Inflammation of the glomeruli results from an antigen-
encephalopathy, pulmonary edema, and heart failure).
antibody reaction produced by an infection elsewhere
Administer diuretics (if significant edema and fluid
in the body.
overload are present), antihypertensives (for
Loss of kidney function develops.
hypertension), and antibiotics (to the child with evidence
of persistent streptococcal infections) as prescribed.
Causes:
Initiate seizure precautions and administer anti-
Immunological diseases convulsants as prescribed for seizures associated with
Autoimmune diseases hypertensive encephalopathy.
Streptoccocal infection, group A, B-hemolytic
Instruct the parents to report signs of bloody urine, The peak incidence is at 3 years of age.
headache, or edema. The occurrence is associated with a genetic
instruct the parents that the child needs to obtain inheritance and with a several congenital anomalies.
treatment for infections, specially sore throats and upper Therapeutic management includes a combined
respiratory infections. treatment of surgery (partial to total nephrectomy) and
chemotherapy with or without radiation, depending on
Nephrotic Syndrome the clinical stage and histologic pattern.
to reduce the excretion of urinary protein The tumor originates from immature renoblast cells
maintain protein free urine. located in the renal parenchyma.
It is well encapsulated in early stages, but it may later
Assessment Findings: extend into lymph nodes and the renal vein or vena
cava and metastasize to the lungs and other sites.
Child gains weight.
Periorbital and facial edema is most prominent in the It is classified into five stages:
morning.
Leg, ankle, labial or scrotal edema occurs. Stage I tumor is confined to one kidney.
Urine output decreases; urine is dark and frothy.
Abdominal swelling occurs. Stage II tumor extends beyond kidney but can be resected.
Blood pressure is normal or slightly decreased.
Stage III tumor has residual nonhematogenous tumor cells
Interventions: confined to the abdomen.
Monitor vital signs, intake and output, and daily Stage IV tumor is characterized by distant metastases
weights. involving lung, liver, bone, or brain.
Monitor urine for specific gravity and albumin.
Monitor for edema. Stage V tumor involves both kidneys.
Nutrition: A regular diet without added salt is
prescribed if the child is in remission; sodium is
restricted during periods of massive edema.
Assessement Findings:
Corticosteriod therapy is prescribed as soon as the
diagnosis has been determined (monitor child closely Swelling or mass within the abdomen (mass is
for signs of infection). characteristically firm, nontender, confined to one
Immunosuppressant therapy may be prescribed to side,and deep within the flank.
reduce the relapse rate and induce long term Abdominal pain
remission; therapy may be administered along with Urinary retention and/or hematuria
the corticosteroid. Anemia (caused by hemorrhage within the tumor)
Diuretics may be prescribed to reduced edema. Pallor,anorexia, lethargy (resulting from anemia)
Plasma expanders such as salt-poor human albumin Hypertension (caused by secretion of excess
may be prescribed for the severely edematous child. amounts of rennin by the tumor)
Instruct the parents about testing the urine for Weight loss and fever
albumin, medication administration, side effects of Symptoms of lung involvement such as dyspnea,
medications, and general care of the child. shortness of breath, and pain in the chest, if
Instruct the parents regarding the signs of infection metastasis has occurred.
and the need to avoid contract with other children
who may be infectious. Interventions Preoperatively: