By

Hidayatullah
MSc.N, BSc.N
URINARY TRACT INFECTIONS
Definition
UTI is the presence of bacteria in the urine
Infection usually occur at the upper urinary tract or
at the lower urinary tract

Incidence
Common age of onset for UTI is 2-6 years
Girl>Boy - Female has shorter urethra
Uncircumcised male prone to develop UTI
 Causes
Causative organisms – E. Coli
Route of entry -bacteria ascending from the area
outside of the urethra.
Vesico-ureteral reflux
Infections – URTI, GE
Poor perineal hygiene - fecal organisms are the
most common infecting organisms due to the
proximity of the rectum to the urethra.
Short female urethra
 Types of UTI
Urethritis – infection of the urethra

Cystitis – an infection in the bladder that has

moved up from the urethra

Pyelonephritis – a urinary infection of the

kidney as a result of an infection in the
urinary tract
Diagram of cystitis
Unexplained fever Poor
(febrile fits)
Abdominal growth
Foul-smelling
pain urine

Irritability
Poor feeding Weight loss
Vomiting (failure to weight gain)
Urinary Nausea and vomiting
frequency/urgency Low abdominal or flank
Dysuria
pain
Foul-smelling urine Fever and chills
Cloudy urine Fatigue
Incontinence during day Small amount of urine
and/or night while micturating despite
Increased irritability feeling of urgency
Central pyrexia but peripherally cold
Poor colour
Pale, grey mottled skin
Quiet and lethargic child
Poor tone
Tachycardic and hypertensive
Diagnostic investigations
 Obtaining a urine specimen:-
- Urine bag
- Clean catch urine
- Mid-stream urine
- Catheterisation

- Supra-pubic aspiration-draining the bladder by

inserting a sterile needle through the skin above the
pubic arch and into the bladder.
 Diagnostic investigations
 Ultrasound
 Plain x-ray
 Micturating Cystourethrogram (MCUG)
 Nursing care
Obtain urine specimen before antibiotics started, sent
for ME/CS
Blood tests
Strict I/O chart
Monitor vital signs esp. body temperature
Administer antibiotics as prescribed (5 days course)
Administer anti-pyretic drugs to reduce fever and pain
Advised to take plenty of fluids to prevent
dehydration and to flush the urinary tract
If the child is unable (vomiting) or refuse to take
fluids, administer IV fluids as prescribed
Health teaching to prevent UTI
Ensure the child to pass urine regularly (every 2-3
hours) and take the time to completely empty the
bladder
Avoid holding urine for prolonged period of time
Perineal hygiene - wipe from front to back
Avoid tight fitting clothing or diapers; wear cotton
panties
Avoid constipation
Encourage fluid intake
Avoid bubble baths
What is Nephrotic Syndrome?
Alteration of glomerular membrane
permeability with massive proteinuria,
hypoalbuminaemia, hyperlipidaemia
and oedema
 Causes
It occurs when the filters in the kidney leak an
excessive amount of protein. The level of protein in
the blood ↓ and this allows fluid to leak across the
blood vessels into the tissues – causing oedema
Nephrotic syndrome are caused by changes in the
immune system
Pathophysiology
For unknown reason, the glomerular membrane,
usually impermeable to large proteins becomes
permeable.
Protein, especially albumin, leaks through the
membrane and is lost in the urine.
Plasma proteins decrease as proteinuria increase.
The colloidal osmotic pressure which holds water in the
vascular compartments is reduced owing to decrease amount of
serum albumin. This allows fluid to flow from the capillaries
into the extracellular space, producing oedema.
Accumulation of fluid in the interstitial spaces and peritoneal
cavity is also increased by an overproduction of aldosterone,
which causes retention of sodium.
There is increased susceptibility to infection due to decreased
gamma-globulin.
Causing generalised oedema
 Incidence
1 : 50 000 children
Males > females
Common age of onset is between 2 to 6 years, but can
occur at any age
 Signs & Symptoms
Oedema ↓ urine output
- initially noted in the Proteinuria (foamy urine
periorbital area indicates proteinuria)
- ascites Fatigue

- intense scrotal oedema Irritable and depression

- striae may appear due Severe recurrent infections

to skin overstretching Anorexia

- pitting oedema Wasting of skeletal muscles

↑ weight
 Diagnostic investigations
Urinalysis
- protein 3+ - 4+ on dipstick
- haematuria may be absent or microscopic
Diagnostic investigations…con’t
Blood test
- total serum protein – low
- serum albumin – low
- cholesterol and lipoproteins – high
Renal function test – often normal
Blood pressure – often normal but 25% hypertension
Renal biopsy
Renal biopsy
Nursing Care
Goal : to relieve oedema
Nursing interventions
Administer steroids – prednisolone 2-4mg/kg to control
oedema
Observe for side-effects of steroids – Cushing’s syndrome
(moon face, abdominal distension, striae, ↑ appetite, ↑
weight, aggravation of adolescent acne)
Administer diuretic – frusemide. Diuretics can cause
loss of electrolytes esp. potassium, encourage ↑
potassium food e.g. citrus fruits, date, apricot, banana
Keep the child CRIB during periods of severe oedema
Strict I/O chart – restrict intake of fluid – offer small
amount of measured fluid during severe oedema, for
infant measure the diaper’s wt.
Measure daily weight and abdominal girth – to check
any weight gain due to water retention
 Nursing Care

Goal : to protect the child from skin breakdown

Nursing intervention
Position the child comfortably in bed so that
oedematous skin is well-support with a pillow
Elevate the child’s head to reduce peri-orbital oedema
Provide good skin care – give bath and maintain
hygiene esp. genitals and moist area
Change bedding daily and free from creases and sharp
objects – to avoid cut
 Other Nursing Management
Admission to ward
Explain parents the nature of illness
Blood for FBC/DC, U +E, Creat., Serum lipid, C&S, LFT,
serum albumin
For C-XR and Echo
Daily urine dipstick for protein, ME every morning
Daily BP, weight and abdominal girth
Start on IV infusion
 Nursing Management…con’t
Administration of IV albumin
Start on steroid therapy – prednisolone given at a dose of
2mg/kg/day divided into 2-3 doses. This regimen is
continued until remission is achieved
Remission is achieved when the urine is 0 or trace for
protein for 5 to 7 consecutive days
Administer prophylactic antibiotics to reduce infections
Nursing Management…con’t
Start on diuretic therapy – frusemide (lasix)
Dietary restriction – provide ↑ protein, high
carbohydrate, ↑ potassium diet & no salt diet
Strict I/O chart
Provide careful skin care
Good hygiene
Acute Glomerulonephritis

Immune-complex disease which causes

inflammation of the glomeruli of the
kidney as a result of an infection
elsewhere in the body.
 Etiology/Pathophysiology

 Usual organism is Group A beta-hemolytic streptococcus

 Organism not found in kidney, but the antigen-antibody

complexes become trapped in the membrane of the
glomeruli causing inflammation, obstruction and edema in
kidney

 The glomeruli become inflamed

and scarred, and slowly lose their
ability to remove wastes and excess
water from the blood to make urine.
AGN
Treatment and nursing care:
Bed rest may be recommended during the acute phase
of the disease
A record of daily weight is the most useful means for
assessing fluid balance
Nursing care specific to the child with
AGN
Allow activities that do not expend energy
Diet should not have any added salt
Fluid restriction, if prescribed
Monitor weights
Education of the parents
Therapeutic management
Corticosteroids (prednisone)
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications: infections, severe GI
upset, ascites, or respiratory distress
Bartter syndrome
Definition
Bartter syndrome is a group of rare conditions that
affect the kidneys and characterized by poly urea
wasting of Na, K, increase aldosterone, renin,
hypotension, and growth failure .
 Alternative Names
Potassium wasting; Salt-wasting nephropathy
Causes
There are five gene defects known to be associated
with Bartter syndrome. The condition is present at
birth (congenital).
The condition is caused by a defect in the kidneys'
ability to reabsorb sodium. Persons affected by Bartter
syndrome lose too much sodium through the urine.
This causes a rise in the level of the hormone
aldosterone, and makes the kidneys remove too much
potassium from the body. This is known as potassium
wasting.
The condition also results in an abnormal acid balance
in the blood called hypokalemic alkalosis, which
causes too much calcium in the urine.
Symptoms
This disease usually occurs in childhood. Symptoms include:
Constipation
Growth failure
Increased frequency of urination
Low blood pressure
Kidney stone
Muscle cramping and weakness
Fetal polyuria
Polyhydramnios
Nephrocalcinosis
Diagnostic test
Blood:
 K, Cl
Renin, aldosterone and PH

Urine:
 K, NaCl and Ca

Biopsy of the kidney

Treatment
eating foods rich in potassium
taking potassium supplements
salt and magnesium supplements
High doses of nonsteroidal anti-inflammatory drugs
(NSAIDs).