Disorders of Genitourinary
Function
Chapter 31
Genitourinary
• Common in children
• Caused by a variety of factors
• Responsible for maintaining fluid &
electrolyte balance within the body
• May be potentially life threatening
Urinary Tract Infection
• May affect the upper urinary tract or
lower urinary tract or both
• More prevalent in females,
uncircumcised males, and sexually
active adolescents
• Most frequently gram negatives
organisms
UTI
• Shorter urethra in females
• Urinary stasis
• Congenital anomaly
UTI
• Signs & symptoms
• May be subtle
• Infants
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Fever
Weight loss
Failure to thrive
Feeding difficulties
Vomiting & diarrhea
• Children
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Urinary frequency
Pain during urination
Foul smelling urine
Incontinence
Abdominal or flank
pain
• Hematuria
• Vomiting
Nephrotic Syndrome
(Nephrosis)
• Clinical state characterized by:
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Proteinuria
Edema
Hyperlipidemia
Hypoproteinemia
• Three forms
• Idiopathic or primary – most common
• Secondary
• Congenitally acquired
Nephrotic Syndrome
• Etiology
• 90% cause is unknown
• Autoimmune & hypersensitivity to an antigenantibody reaction - possible causes
• Proteinuria – results from glomerular damage that
renders the glomerulus permeable to protein
• Leads to low levels of protein in the blood
• Decreases colloidal osmotic pressure in the
capillaries
Nephrotic Syndrome
• Edema
• Hypovolemia
• Compensation – kidneys retain sodium
& water
• Level of lipids increasing – poorly
understood
Nephrotic Syndrome
• Clinical manifestations
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Subtle
Periorbital edema
Abdominal distention - ascites
Anasarca
Vomiting
Anorexia/diarrhea
Irritability
Nephrotic Syndrome
• Hallmark signs
• Increased body weight
• Decreased urine output
• Marked edema
Nephrotic Syndrome
• Diagnostic tests
• Clinical manifestations
• Urine studies
• Marked proteinuria
• High specific gravity
• May be dark & frothy
• Serum protein levels reduced
• Serum lipid levels elevated
• Renal biopsy
Nephrotic Syndrome
• Medical management
• Principal goal – reduce edema
• Steroid therapy – adrenocortical - reduce proteinuria &
then edema
• Response – 7 to 21 days
• Taper once asymptomatic
• Bedrest – progression to ambulation
• Low sodium diet
• No diuretics
• Relapse
Nephrotic Syndrome
• Nursing
• Observation & monitor
• I&O, body wt, abdominal girth
• Skin care
• VS
• Nutrition – good protein intake
• Steroids – risk of infection
• Activity increase
• Support of family
Nephrotic Syndrome
• Instruct parents
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Test urine for albumin
Admin meds
Diet restrictions
Side effects
Assess for signs of relapse
Nephrotic Syndrome
• Prognosis
• Good response – early detection & therapy
start
• Remissions – prolonged if follow
instructions
• Ultimate recovery - good
Acute Glomerulonephritis
• Inflammation of the glomeruli of the
kidney
• Postinfection phenomenon
• APSGN – most common – early school
age children
APSGN
• Follows a strep infection of the throat or
skin
• Fixed to basement membrane of
glomeruli
• Become edematous & infiltrated with
WBCs
• GFR decreases – Accumulation of Na &
H2O
APSGN
• Circulatory
congestion & edema
• Proteinuria from
inflammation &
damage
APSGN
• Clinical manifestations
• 10-14 days after the infection
• Sudden onset – hematuria, proteinuria,
oliguria
• Tea or cola colored urine
• Edema, abdominal pain, pallor, low grade
fever, anorexia, vomiting, & h/a
• HTN & hrt failure - hypovolemia
APSGN
• Diagnostic tests
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UA – proteinuria, hematuria, elevated SG
Urine culture – negative
Cultures of throat/skin – strep positive
Antistreptolysin O - elevated
APSGN
• Medical management
• Acute phase – 1-2 weeks
• Bed rest recommended
• Restricted fluid, sodium, potassium,
phosphate – initially
• VS, body wt, I&O
• Antihypertensive & diuretics - control HTN
• Antibiotic therapy
APSGN
• Nursing
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Promote rest & adequate nutrition
Prevent & detect complications
Support
Educate parents
APSGN
• Prognosis
• Recover completely
Wilm’s Tumor
(Nephroblastoma)
• Most common malignant tumor of
childhood
• 20% of solid tumors in children
• Peak age – 2 to 3 years
Wilm’s
• Etiology
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Most commonly – left kidney
Both – 10% of cases
Hereditary & non hereditary origins
Metastasis sites – lungs, lymph nodes,
liver, brain, & bone
Wilm’s
• Clinical manifestations
• Enlarging, asymptomatic, and firm
abdominal masses
• Abdominal pain, hematuria, fever, HTN, wt
loss, & fatigue
• Metastasis – dyspnea, cough, & chest pain
Wilm’s
• Diagnostics
• Detected by parents
• Physical exam
• Radiographic
• CT
• Hematologic & chemistry studies
• Definitive – surgical biopsy
• DO NOT PALPATE
Wilm’s
• Medical management
• Surgical resection
• Extent and metastasis
• One affected - tumor, kidney, & adrenal gland
• Both – part of kidney, total kidney on opposite
side
• Radiotherapy
• Chemotherapy
Wilm’s
• Nursing
• Preop
• Prepare family
• Postop
• Bowel sounds
• Renal function
• Support family
• Return to normal lifestyle
Wilm’s
• Prognosis
• Excellent
• Localized tumor –
90% chance
• 5 year survival rate
is 90-93%
Structural Defects
• Hypospadias
• Urethral opening located along the ventral
(anterior) surface of the penile shaft
• Surgical correction – extending the
urethra to a normal position
• Normal reproductive and urinary
function
Structural Defects
• Epispadias
• Urethral opening located along the dorsal
(posterior) surface of the penile shaft
• Surgical correction – penile and urethral
lengthening and possible bladder neck
reconstruction
Structural Defects
• Phimosis
• Narrowing or stenosis of the opening of
the foreskin
• Mild – manual retraction
• Severe - circumcision
Structural Defects
• Hydrocele
• Fluid in the scrotal sac
• Surgical correction – if not resolved
spontaneously in one year
Structural Defects
• Cryptorchidism
• Failure of one or both testes to descend
into the scrotum
• Medical management – human
chorionic gonadotropin
• Surgical correction – orchiopexy
• Prevent testicular damage and
malignancies
Structural Defects
• Inguinal hernia
• Protrusion of the abdominal organs
through the inguinal canal and into the
scrotal sac
• Surgical correction - closure