Child with Renal or Urinary Tract Disorder

• This chapter adds information about the dramatic changes, both physical and psychosocial, that occur when children develop urinary tract or renal disorders.
• Key terms

  • Alport's syndrome
  • Azotemia
  • Bowman's capsule
  • Dialysis
  • Enuresis
  • Epispadias
  • Exstrophy of the bladder
  • Glomerular filtration rate
  • Glomerulonephritis
  • Hydronephrosis
  • Hypospadias
  • Nephrosis
  • Patent urachus
  • Polycystic kidney
  • Postural proteinuria
  • Prune belly syndrome
  • Vesicoureteral reflux
• Normally, the urinary system maintains the proper balance of fluid (water) and electrolytes in the blood.
• When disease occurs, such as with structural abnormalities or kidney malfunction, children may be left with excessive amounts of fluid in the body or with an imbalance of electrolytes essential to their body's functioning.
• Disorders involving the kidneys and urinary tract often are long term.
• Urinary tract disorders can ultimately (if not originally) affect the kidneys, resulting in kidney dysfunction, with potentially fatal consequences.
• "I kept asking everyone why she was gaining so much weight when she doesn't eat anything," her grandmother tells you.
• This chapter adds information about the dramatic changes, both physical and psychosocial, that occur when children develop urinary tract or renal disorders.
• This information builds a base for assessment, care, and health teaching.
• Alport's syndrome


  Renal disorder
• Azotemia


  Excess of nitrogenous waste products in the blood
• Bowman's capsule


  Double-walled chamber enclosing the glomerulus
• Dialysis


  Process of filtering waste products from the blood
• Epispadias


  Congenital abnormality in which the urethra opens on the upper surface of the penis
• Exstrophy of the bladder

  Congenital abnormality in which the bladder is turned inside out and protrudes through the abdominal wall
• Glomerular filtration rate


  Rate at which the glomeruli filter water and solutes from the blood
• Glomerulonephritis


  Inflammation of the glomeruli
• Hydronephrosis


  Dilation of the renal pelvis and calyces due to obstruction of urine flow
• Hypospadias


  Congenital abnormality in which the urethra opens on the underside of the penis
• Nephrosis


  Kidney disease characterized by degeneration of the renal tubules
• Patent urachus


  Failure of the urachus to close after birth, resulting in a urine-draining umbilical fistula
• Polycystic kidney


  Genetic disorder characterized by multiple cysts in the kidneys
• Postural proteinuria


  Presence of protein in the urine only when the person is upright
• Prune belly syndrome


  Congenital abnormality characterized by a wrinkled, loose abdominal wall, undescended testes, and urinary tract abnormalities
• Vesicoureteral reflux


  Backward flow of urine from the bladder into the ureters and kidneys
• Normally, the urinary system maintains the proper balance of fluid (water) and electrolytes in the blood.
• When disease occurs, such as with structural abnormalities or kidney malfunction, children may be left with excessive amounts of fluid in the body or with an imbalance of electrolytes essential to their body's functioning.
• Disorders involving the kidneys and urinary tract often are long term.
• Urinary tract disorders can ultimately (if not originally) affect the kidneys, resulting in kidney dysfunction, with potentially fatal consequences.
• Because symptoms may be vague, or because a child or parents do not realize the seriousness of urinary disease or are embarrassed to discuss it, children may not be evaluated at the first sign of illness.
• Health education to increase the awareness of the symptoms of urinary tract and kidney disorders is an important area of family health teaching.
• School nurses can play an important role in recognizing the seriousness of minor symptoms and making proper referrals for care.
• The ease with which parents and children can discuss illnesses of the kidneys or urinary tract is culturally influenced.
• A hallmark of kidney or bladder infection is pain.
• Urine specimens provide valuable assessment information.
• Techniques for obtaining urine samples such as clean-catch, catheterization, 24-hour collections, suprapubic aspiration, and urinalysis are described in Chapter 37.
• Because the entire family becomes involved in long-term renal disease, other appropriate nursing diagnoses might include: Interrupted family processes related to the effects and stresses of child's chronic illness, Compromised family coping related to the chronic nature of child's illness.
• Be certain that outcomes established for care are relevant to a child's age and condition.
• Planning for a child with a urinary tract or renal disorder often involves helping parents remember to give medicine.
• If a child has severe renal impairment, parents may be asked to make decisions regarding kidney removal and transplantation.