RENAL ASSESSMENT

1) Void/drain bladder.
2) Explain procedure.
3) Position in supine
4) Inspection/assess skin for abnormalities.
5) Auscultation for presence of (+) peristaltic sounds.
6) Percussion using two fingers.
7) Palpation – never palpate a Px with Wilms Tumor
RENAL DISORDER
ACUTE GLUMERULONEPHRITIS
Inflammation of glomerulus
↓
(+) Mild proteinuria → ↓Albumin → Fluid shifting (IVS to IS) → Edema → RAAS activated → ↑BP.
↓
Cola colored urine (blood in urine) and Concentrated/foamy urine
 Albumin – function in fluid shifting and helps kidney to prevent water leakage.
 RAAS - regulator of blood volume, electrolyte balance, and systemic vascular resistance
 TRIAD OF ACUTE GLUMERULONEPHRITIS

Causes:
 Autoimmune such as SLE
 History
 Immunocompromised
 2-5 y.o

MGT:
To decrease inflammation
1. Rest the kidney.
 Low CHON diet
 Low Na diet
 ↓OFI/NPO
2. Diuretics
3. Antihypertensive
 Calcium Chanel Blockers (CCB) “-DIPINE”
o Amlodipine
o Nifedipine
 Check for ↓BP and ↓HR.
 ACE inhibitors “PRIL” – contraindicated to asthma because it causes
bronchoconstriction.
o Captopril
o Enalapril
* ↓HR
* WOF: STOP IF ADVERSE REACTIONS APPEAR.
 Angioedema
 Cough (persistent)
 Elevated K
4. Steroids - anti-inflammatory
 Sugar – hyperglycemia
  ↓Immune system
 Neutropenic precaution (reverse isolation)
o NO flowers, raw foods, fresh fruits, and green leafy vegetables.
5. Seek if patient develops URTI.
6. Monitor I/O, VS, and weight.

A. LOOP (K-wasting) – Furosemide, Torsemide, Bumetanide.

 Check for decrease K.
B. K-sparring – Spironolactone (↓8 y.o.), Triamterene, and Aldactone
 Check of increased K.
C. Thiazide - Hydrochlorothiazide, Indapamide, and Chlorthalidone.
 Check for decreased K but retained Ca.
D. Osmotic Diuretics – helps to prevent cerebral edema.
 Mannitol
 CVA
 Stroke

URINARY TRACT INFECTION

UPPER UTI: SYSTEMIC LOWER UTI: LOCALIZED
 Kidney (Pyelonephritis)  Bladder (Cystitis)
 Ureter (Ureteritis)  Urethra (Urethritis)
S/Sx of U-UTI S/Sx of L-UTI
 Fever, chills  Hypogastric pain (pain sa puson)
 Dysuria  Dysuria
 Polyuria  Polyuria
 Flank pain (pain sa gilid)
CAUSES E. Coli
RISKS  Multiple partners
 Teenagers
 Advanced age
 Immunocompromised
 Have foley catheter
MGT
1. Fluoroquinolones “-FLOXACIN)
2. ↑OFI
3. Front to back cleaning of genitals
 NO feminine wash
 NO douching
 Warm bath
 Void after sex
 NO holding of urine
Dx Procedure
 U/A
 Urine dipstick; pediatric – cotton balls absorb urine from baby’s diaper.
 NEPHROTIC SYNDROME
Damaged glomerulus
↓
Massive proteinuria → ↓Albumin → Fluid shifting (IVS to IS) → Edema → RAAS activated → ↑BP.
↓
Lipoprotein → ↑Fats in kidney

Massive proteinuria → ↓Ig → ↓Immune system

↓
↓Heparin → ↑Clot formation → DVT → Pulmonary Embolism → Stroke → MI

Massive proteinuria → Cola colored urine (blood in urine) and Concentrated/foamy urine

MGT FOR NEPHROTIC SYNDROME:

1. Rest the kidney.
 Low CHON diet
 Low Na diet
 ↑OFI/NPO
2. Steroids – betamethasone and dexamethasone.
3. Antibiotic for prophylactic
 Fluoroquinolones “FLOXACIN”
o IV - slow
o Oral – after meals w/ one full glass of water to avoid crystalluria.
4. Mild diuretics - Spironolactone
5. Antilipidemic - Atorvastatin and Simvastatin (both are hepatotoxic)
 WOF: STOP if adverse reactions appear.
o Jaundice
o Muscle pain – iniinda for 3 months, 1 year, etc.
o Rhabdomyolysis – calcium leaks and goes to kidney -> kidney failure.
6. Anticoagulant
 Short term - Heparin (antidote: Protamine Sulfate)
o aPTT – activated partial thromboplastin time.
o 46-70 secs.
 Long term – Warfarin (Antidote: Vit K)
o International Normal Ratio: 2.0 – 3.0 secs.
o Aquamephyton
*If kidney is bleeding
7. Monitor I/O, VS, and weight.
 Osteomyelitis – infection and inflammation of bones.

Predisposing F.: Precipitating F.:

1. 1-5 y.o. BONE INFECTION
1. ↓Immune system
2. Advanced age
2. Medications
3. Idiopathic
3. Staphylococcus
Aureus
Inflammatory cascade triggeref

Release of enzymes: Cytokine, Prostaglandin, and WBC (Neutrophils)

Bone lysis (Brittle)

Periosteal stripping (Holes)

Sinus formation (pus)

Bone death

Dx Procedures:

1. X-ray
2. MRI
3. CT Scan

Tx:

1. Broad spectrum antibiotics

2. Amputation
3. Analgesics
4. Bone culture
 Spina Bifida Occulta Spina Bifida Cystica
S/Sx: S/Sx: Meningocele & Myelomeningocele
1. Tufts of hair 1. Hydrocephalus
2. Skin dimpling 2. ↑ICP (normal: 5-15 mmHg)
3. ↑Head circumference
Dx Procedures: 4. Projectile vomiting – risk for aspiration
1. MRI
2. CT Scan Dx Procedures:
3. X-ray 1. Transillumination
2. MRI
3. CT scan

MGT: Meningocele & Myelomeningocele

1. Broad spectrum antibiotics
2. Surgery
3. Chemotherapy
4. Radiation

WILM’S TUMOR
Dx Procedures:

 CT Scan
 MRI
 Biopsy
Tx:
 Surgery
 Chemotherapy
 Radiation
STAGES OF WT CANCER:
 Azathioprine – DOC
1. S1 – in one kidney
10% of WT patients: to prevent organ
2. S2 – affected both structure and
 Wilms Tumor rejection.
tissue.
 Aniridia 3. S3 – affected lymph nodes.
 Genitourinary problems 4. S4 – systemic distribution of tumor
 Retardation 5. S5 – affected both kidneys.