Pediatric Renal and

Genitourinary Disorders
This presentation will cover the key topics of chronic renal failure, dialysis, and
renal transplants in pediatric patients. We'll explore the pathophysiology, clinical
manifestations, management, and nursing considerations for these complex
conditions that affect children.

by Raymart Laviña
Chronic Renal Failure
1 Causes
The most common causes of
chronic renal failure in
children are congenital
abnormalities, glomerular
disease, hereditary renal
disease, and renal vascular
disorders.
2 Pathophysiology
Chronic renal failure leads to
a progressive decline in the
kidney's ability to maintain
fluid and electrolyte balance,
resulting in azotemia,
anemia, metabolic acidosis,
and other complications.
3 Clinical Manifestations
Symptoms can include
decreased appetite, polyuria,
bone/joint pain, and pruritus,
with the severity depending
on the degree of renal
function loss.
Managing Chronic Renal Failure
1 Correcting Imbalances
Addressing calcium-phosphorus imbalances, acidosis, and anemia through
medications and dietary modifications is crucial.

2 Dialysis
For end-stage renal disease, dialysis (hemodialysis or peritoneal dialysis) can help
replace some of the kidney's functions and sustain life until transplantation.

3 Transplantation
Renal transplantation is the optimal treatment, offering the best potential for normal
growth and development in pediatric patients.
Nursing Care for Dialysis Patients
Preparing the Child Maintaining Safety Promoting Wellbeing

Dialysis can be frightening for
children, so it's important to
explain the procedure in age-
appropriate terms, allow them to
handle equipment, and address
their fears.
Nurses must monitor for
complications, protect the child
from injury, and ensure proper
infection control during dialysis.
Providing symptom relief,
encouraging independence, and
supporting the child's emotional
and educational needs are crucial
nursing interventions.
Renal Transplantation
Evaluation of Recipient
Key factors in determining transplant eligibility
include the child's age, primary renal disease,
psychological status, and potential for growth and
development.
Emotional Concerns
Children may struggle with the concept of a foreign
body, altered body image, and guilt if a live donor
transplant fails.
Donor Selection
Tissue-compatible living donors, such as siblings or
parents, are preferred, but cadaveric donors may also
be used.
Nursing Interventions
Nurses play a crucial role in supporting the child and
family, preventing infections, administering
immunosuppressants, and monitoring for signs of
rejection.
Transitioning to Home and Community
Home Care
Families must learn to
manage intravenous
medications, central lines,
and other aspects of the
child's care at home.
Community Support Education Follow-up Care
Ongoing support from Comprehensive education Close medical
healthcare professionals, on infection prevention, surveillance and
social workers, and other dietary restrictions, monitoring for signs of
families is essential to medications, and rejection or complications
help the child and family emergency procedures is crucial, as the risk of
cope with the physical, empowers families to malignancy is higher in
psychological, and care for the child at home. transplant recipients.
logistical challenges.
Chronic Renal Failure: Complications

Growth Retardation Anemia Hypertension

Chronic renal failure can lead to
delayed or absent sexual
maturation and stunted growth
due to metabolic disturbances.
The kidneys' inability to produce
erythropoietin, combined with
uremic toxins and nutritional
deficiencies, can result in severe
anemia.
Renal ischemia stimulates the
renin-angiotensin system, leading
to hypertension and an increased
risk of congestive heart failure.
Chronic Renal Failure: Nursing Diagnoses

1 Risk for Injury 2 Fluid Imbalance

Hypocalcemia can lead to seizures and other Nurses must carefully manage fluid intake and
neurological complications, requiring close output to prevent both fluid overload and
monitoring and interventions to maintain safety. dehydration in children with renal failure.

3 Altered Nutrition 4 Activity Intolerance

Dietary restrictions and gastrointestinal Fatigue and anemia can limit the child's ability to
disturbances can lead to malnutrition, requiring participate in physical activities, necessitating a
close monitoring and nutritional support. careful balance between rest and activity.
Chronic Renal Failure: Nursing Interventions
Ensuring Safety Protecting the child from the effects of decreased
consciousness, monitoring for seizures, and closely
tracking lab values.

Promoting Fluid Balance Carefully managing fluid intake and output to prevent
both overload and dehydration.

Ensuring Adequate Nutrition Providing a diet that meets the child's needs while
adhering to necessary restrictions on protein,
electrolytes, and fluids.

Increasing Activity Tolerance Encouraging activity as tolerated, while avoiding

excessive exercise to reduce metabolic waste, and
administering blood transfusions as needed.

Enhancing Coping Supporting the child and family in dealing with the
uncertainty, lifestyle changes, and emotional
challenges of chronic renal failure and dialysis.
Renal Transplantation: Nursing
Considerations
Preoperative Support
Nurses must support the child and
family through the extensive
testing and preparation required
for a successful transplant,
including addressing any
emotional or psychological
concerns.
Postoperative Care
After the transplant surgery, nurses
must maintain strict infection
control, administer
immunosuppressant medications,
monitor for signs of rejection, and
provide ongoing support to the
child and family.
Community Transition
As the child is discharged from the
hospital, community and home
care nurses play a crucial role in
managing the child's intravenous
medications, central lines, and
other aspects of their care, while
also providing emotional support
and education to the family.