Management for UTi

- Oral administration of broad spectrum antibiotic such as Sulfamethoxazole-trimethoprim

(Bactrim) or Amoxicillin, or an antibiotic specific to the causative organism that is cultured.
- Nitrofurantoin is also a good choice for UTIs because it is a broad-spectrum antibiotic
- drink a large quantity of fluid to “flush” the infection out of the urinary tract
- Cranberry juice is often recommended as being highly effective in acidifying urine
and making it more resistant to bacterial growth
- water is the best choice; fluids with artificial coloring and carbonation should be
avoided because they irritate the bladder and can cause further discomfort.
- suggest the child sit in a bathtub of warm water and void into the water. If the child
experiences moderate to severe pain on urination that interferes with the ability to
void
- mild analgesic, such as acetaminophen (Tylenol), may help reduce pain enough to
allow voiding.

Treatment for Vesicoureteral Reflux:

- Teaching double voiding
- Prophylactic antibiotics for a lengthy time to prevent bladder infection from
reoccurring.
- cystoscopy.
- dextranomer–hyaluronic acid (Deflux) is injected to stabilize the ureter
valves
- laparoscopic surgery can be scheduled to reinsert the ureters at a more oblique angle.
- antispasmodics are usually prescribed to reduce bladder spasm.
- Remind the child and parents to avoid tub baths until the suprapubic tube site has
closed completely.

Treatment for Hydronephrosis

- surgical correction of the obstruction before glomerular or tubular destruction occurs.

Treatment for Enuresis:

- limit fluids during the 2 hours before bed
- a synthetic antidiuretic hormone (desmopressin) administered orally is the drug of
choice to reduce urinary output and nocturnal enuresis

Treatment for Polycystic Kidney:

- surgical removal of the diseased kidney if only one is cystic
- If both kidneys are cystic, treatment is renal transplantation
Treatment for Acute Glomerulonephritis
- antibiotics may be prescribed to be certain all streptococci are removed from the
child’s system.
- If heart failure occurs, keeping the child in a semi-Fowler’s position, digitalization
(digitalis/digoxin), and oxygen administration are helpful.
- If diastolic blood pressure rises to more than 90 mmHg, antihypertensive therapy with
an antihypertensive such as labetalol will be prescribed.
- Phosphate binders, such as aluminum hydroxide to reduce phosphate absorption in the
gastrointestinal tract, or a potassium-removing resin agent, such as sodium
polystyrene sulfonate (Kayexalate), may be necessary in children who have rising
phosphate and potassium levels because the kidneys are unable to clear these from the
circulation.

Treatment for Nephrotic Syndrome

- a course of corticosteroids, such as IV methylprednisolone or oral prednisone
- keeping the child free of infection
- initial dose of prednisone is given until diuresis without protein loss is accomplished;
- Children who respond poorly to prednisone alone, however, may need
diuretic therapy with a drug such as furosemide (Lasix) to initiate more kidney
function.
- IV albumin may be administered to temporarily correct hypoalbuminemia.

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Treatment for Acute Renal Failure

- If the child is dehydrated (as with diarrhea or hemorrhage), IV fluid is needed to
replace plasma volume.
- Be certain the fluid prescribed does not contain potassium until it is established that
kidney function is adequate; otherwise, the buildup of potassium could cause heart
block.
- Potassium levels greater than 6 mEq/L are corrected by the IV administration of
calcium gluconate by the oral administration of a cation exchange resin such as
sodium polystyrene (Kayexalate),or by dialysis.
- Administering sodium bicarbonate is another method for causing a shift of potassium
from the bloodstream into cells, temporarily reducing the circulating potassium level.
- The child’s diet should be low in protein, potassium, and sodium and high in
carbohydrate to supply enough calories for metabolism yet limit urea production and
control serum potassium levels

- Oral fluid intake may be limited to prevent heart failure due to accumulating fluid that
cannot be excreted.
Treatment for Chronic Renal Failure
- a low-protein, low phosphorus, low-potassium diet to prevent rapid urea and
phosphate buildup.
- Milk usually is not given because it is high in sodium, potassium, and phosphate—
electrolytes children may have difficulty clearing.
- Meat is restricted, and even beans are high enough in protein to be eliminated,
- As renal failure becomes prolonged, a child needs supplemental calcium to prevent
muscle cramping, rickets, tetany, or seizures.
- Dialysis is the answer to effective excretion of urea while children wait for a kidney
transplant to replace their nonfunctioning kidneys.