Download 12 Physiologicoanatomical features of the renal system in children

Theme of lectures.
Anatomy-physiological features of
renal system in children. Semiotics of
lesion, clinical manifestation. Acute
renal failure. Medical care
of the child with renal failure.
Doc. Nykytyuk S.
Normal Kidneys and Their
Function
EMBRIOLOGY
11-15 days since fertilization-mesoderm
21-25 days-pronephros develops aliantois appears
26-30 days-mesonephros appears
31-35 days- metanephros begins to develop
51-55 days-mesonephros degenerate
56-60 days- anal portion of cloacal membrane
reptures
The kidneys are a pair of beanshaped organs
 that lie on either side of the spine in the lower
middle of the back. Each kidney weighs about ¼
pound and contains approximately one million
filtering units called nephrons. Each nephron is
made of a glomerulus and a tubule. The
glomerulus is a miniature filtering or sieving
device while the tubule is a tiny tube like structure
attached to the glomerulus.
 The kidneys are connected to the urinary bladder
by tubes called ureters. Urine is stored in the
urinary bladder until the bladder is emptied by
urinating. The bladder is connected to the outside
of the body by another tube like structure called
the urethra.
 The main function of the kidneys is to remove
waste products and excess water from the blood.

















1. Renal pyramid
2. Efferent artery
3. Renal artery
4. Renal vein
5. Renal hylum
6. Renal pelvis
7. Ureter
8. Minor calyx
9. Renal capsule
10. Inferior renal capsule
11. Superior renal capsule
12. Afferent vein
13. Nephron
14. Minor calyx
15. Major calyx
16. Renal papilla
17. Renal column
Renal structure and physiology
The structural and functional unit of the kidney is
the nephron, which is composed of a complex
system of tubules, arterioles, venules, and
capillaries.
The nephron consists of:
 Bowman's capsule, enclosing the capillary tuft of
the
glomerulus, which is joined successively to the
proximal
convoluted tubule,
 Henle's loop,
 the distal convoluted tubule,
 the straight or collecting- duct.
Fibrous system of renal
Fibrous
connective tissue
(lig.hepatorenale, lig. lienorenale, lig.
duodenorenale)
Renal vessels
Adipose tissue
Renal fascia
Renal function

Maintaining the electrical, chemical,
concentration and acid-base
balances and the integrity and volume of
body fluids at a constant level.
 Elimination of metabolic by-products and
unessential chemicals
dissolved in water (desintoxication).
 The production of certain humoral
substances:
Humoral substances:


erythropoietic stimulating
factor (ESF, or
erythrogenin), which
acts on a plasma globulin
to form erythropoietin;
renin, which is secreted by
the kidneys in response to
reduced
blood volume, decreased
blood pressure, or
increased secretion
of catecholamines;


renin stimulates the
production of
angiotensins, which
produce
arteriolar constriction and
an elevation of blood
pressure
and stimulate the
production of aldosterone
by the adrenal
cortex.
calcitriol, the active form
of vitamin D, which helps
maintain calcium for bones
and for normal chemical
balance in the body
These functions are based on 3 processes
that provide the urine production:
 Processing (ultrafiltration) the blood
plasma.
 Reabsorption of the most part of fluid and
electrolytes from
the primary urine by the renal tubules.
 Excretion of certain substances into the
tubular urine.
These processes are dynamic, and what is
excreted as waste in one moment may be
retained as precious in the next.
Kidneys play an important part in a
child's growth and health.
They
 remove wastes and extra water from the
blood
 regulate blood pressure
 balance chemicals like sodium and
potassium
 make a hormone that signals bone marrow
to make red blood cells
 make a hormone to help bones grow and
keep them strong

The peculiarities of kidney function in early
infancyfiltration rate is low and does not reach adult values until
Glomerular
the child is between 1 and 2 years of age

There is a large variation in the tubular length between nephrons,
although glomerular size is less variable.

The juxtaglomerular nephrons show more advanced development than
cortical nephrons.

The concentrating ability of the newborn kidney does not reach adult
levels until about the third month of life.

Adequate amounts of antidiuretic hormone are secreted by the
newborn pituitary gland, other factors appear to interfere with water
reabsorption.

The peculiarities of kidney function in early
infancy
Urea
synthesis and excretion are slower during
this time.

The newborn retains large quantities of nitrogen
and essential electrolytes in order to meet needs
for growth in the first weeks of life.

Consequently the excretory burden is minimized.

The lower concentration of urea, the principal
end product of nitrogen metabolism, reduces
concentrating capacity, since it also contributes
to the concentration mechanism.
The peculiarities of kidney function in early
infancy




Hydrogen ion excretion is reduced.
Acid secretion is lower for the first
year of life.
Plasma bicarbonate level is low
As a result of these inadequacies of
the kidney and less efficient blood
buffers, the newborn is more liable
to develop severe acidosis.
The peculiarities of kidney function in early
 infancy
Sodium excretion is reduced in the immediate


newborn period, and the kidneys are less able to
adapt to deficiencies and excesses of sodium.
An isotonic saline infusion may produce edema
because the ability to eliminate excess sodium is
impaired.
Conversely inadequate reabsorption of sodium from
tubules may compound sodium losses in disorders
such as vomiting or diarrhea.
Infants have a diminished capacity to reabsorb
glucose and, during the first few days, to produce
ammonium ions.
Anatomo- physiological
perculiarities of urinary system
Kidneys
 - has biggest sizes than in adults
 -situated more lower
 -has very thin fibrous capsule,
absence of fat parietal fat capsule in
newborns;
 -bad fixation of kidneys leads to
physiological mobility of them in
newborns period to 1,5-2,0 sm and in
children under 7 years 1-1.5 sm
Renal pelvis
- has biggest sizes in newborns and
children under 1 year
 -bad developed walls and
physiological hypotonia under 7
years;
 -different forms, branches;
 All perculiarities helps to retention of
urine- inflamation process.

Ureters
They are more wide more big unders
7 years (dilated lengthenedureteres)
 Has the presenes of physiological
kinks (twists), when it is situated
near the pelvis big vassels.
- bad development of muscls lear
under 3 years
- Wrinkled mucus to the and of 1 year.

Urethral canal, urethra
Is more wide, short in children under
3 years
- external urethral meatus is opened in
girl 3 yeas
-
Urinary bladder
Situated more upper (in children under 3 years can
be find in public redion of the abdomen) can be
palpate)
- poor development of vascules elastic tissue
under 6 years
- Ureteric mouth (orifice) are commonly opened.
That’s why in very often developed vesicoureteric
reflux, ureteric torsion.
Very good developments vascularisation of bladder
mucose, leads to development inflammation
process of the ureter.
Kidney channels
More shorts, has small
diameter than in adult
especially in the peripheral
parts of the kidney
Capacity of the urinary bladder
Newborn
1 year
1-3year
3-5 year
5-9 year
9-12 year
till
30ml
35-50 ml
50-90 ml
100-150ml
200ml
200-300 ml
400 ml
Morphological peculiarities
Kidney (renal) glomerulus
The differentiation of glomerulusis not
ended at all
They have small sites
The structure of epithelium – is
cylindrical
All peculiarities leads to small filtrate
surface of glomerulus.
Glomerular filtration (filtrative
function is more lower)
- poor reabsorbtive function
- poor water pass function
- Small ability to concentrate urine
- The physiological urine acidinfarction of kidney in newborns
- Physiological anuria in newborn
- Great frequency at urination after 3-5
days of life.
Localization of kidney.
Newborn – in the level I - V thoracic
vertebras.
 Older children - X thoracic and IV
lumbal vertebras.

Length of the ureter

newborn– 6-7 sm
 1 year – 10 sm
 4 year – 15 sm
 Older of 4 year and adult – 20-28 sm
Urethral canal
Short
urethra
A little mucous and elastic tissue
Wide urethra in a girl
Daily diuresis
1 month – 200-300 ML
 1 Year – 600 ML
 In children 1-10 years for the EMPIRICAL

FORMULE: 600 + 100 (N – 1), N – years of this
child
 Children, older 10 years, have daily diuresis, as
adults – 1700-2000 ML
Volume of urination
– 10-15 ml
6 month – 30 ml
1 year – 60 ml
3-5 years – 90-100 ml
7-8 years – 150 ml
10-12 years – 250 ml
Newborn
Specific gravity of urine

Newborn 1006-1012
1-12 month – 1002-1006
2-5 years – 1009-1016
10-12 years – 1012-1025
Investigation of the child with urinary pathology:
1.
General condition.
2. Activity.
4.Skin ( color, dryness,).
5. Mucous of the mouth ( state, color).
Sizes and form of abdomen.
7. Changes of activity during diuresis.
Patients complaints and methods of physical
examination
The examination of kidneys is impossible without
laboratory urine tests. So in this chapter the data
of physical examination and interpretation of
urine tests will be located together for convenient
use.
All symptoms in case of kidney disorders are
divided into renal and extrarenal.
Renal symptoms are such clinical signs that directly
show on the disorders of kidneys and any part of
the collecting system. They are lumbar region
pains (costovertebral angle tenderness, flank
pain), dysuria and syndrom of urine changes.
Only children after 2 years can complain on
lumbar region pains, because in this age
cortex tissue and renal capsule reach their
mature form. The "kidney" pain is caused
by expanded capsule. This pain can be
found by palpation of kidneys and by
Pasternatskiy's sign. Very often children 2
till 5 years of age complain on abdominal
pain in case of renal problems. In infants
"kidney" pain can be evident as constant
squirming, irritability.
Causes of "kidney"pain:





1 - expansion of calyces
and renal pelvis;
2 - expansion of capsule;
3 - compression of
receptors;
4 - renal ischemia;
5 - refluxes.
Dysuria
means problems with urination. This
term is most often used like a
synonym to painful urination, but it
also includes such changes as:
 frequent or infrequent voiding;
 urinary urgency;
 incomplete voiding;
 enuresis.
Symptoms of Kidney Disease
Changes in Urination
Kidneys make urine, so when the kidneys
are failing, the urine may change. How?
 to get up at night to urinate.
 Urine may be foamy or bubbly. Urinate
more often, or in greater amounts than
usual, with pale urine.
 Urinate less often, or in smaller amounts
than usual with dark colored urine.
 Urine contain blood.
 Feel pressure or have difficulty urinating.
Symptoms of Kidney Disease
Swelling
Failing kidneys don't remove extra fluid,
which builds up in body causing swelling
in the legs, ankles, feet, face, and/or
hands.
Fatigue
Healthy kidneys make a hormone called
erythropoietin that tells body to make
oxygen-carrying red blood cells. As the
kidneys fail, they make less
erythropoietin. With fewer red blood cells
to carry oxygen, muscles and brain
become tired very quickly.
Symptoms of Kidney Disease
Skin Rash/Itching
Kidneys remove wastes from the
bloodstream. When the kidneys fail, the
buildup of wastes in blood can cause
severe itching.
Metallic Taste in Mouth/Ammonia Breath
A buildup of wastes in the blood (called
uremia) can make food taste different and
cause bad breath. Stop liking to eat meat,
or Losing weight.
Symptoms of Kidney Disease
Nausea and Vomiting
Loss of appetite can lead to weight loss.
Feeling Cold
Anemia can make feel cold all the time, even
in a warm room.
Dizziness and Trouble Concentrating
Anemia related to kidney failure means that
brain is not getting enough oxygen. This
can lead to memory problems, trouble
with concentration, and dizziness.
Symptoms of Kidney Disease
Leg/Flank Pain
Some children with kidney problems
may have pain in the back or side
related to the affected kidney.
Polycystic kidney disease, which
causes large, fluid-filled cysts on the
kidneys and sometimes the liver, can
cause pain.
What are the causes of kidney failure in children?
Kidney failure may be acute or chronic.
Acute diseases develop quickly and can
be very serious. Although an acute
disease may have long-lasting
consequences, it usually lasts for only a
short time and then goes away once the
underlying cause has been treated.
Chronic diseases, however, do not go
away and tend to get worse over time.
When the kidneys stop working, doctors
use a treatment called dialysis to remove
waste products and extra water from
patients with chronic kidney failure.
Acute Kidney Diseases
Acute kidney disease may result from an injury or from
poisoning. Any injury that results in loss of blood may
reduce kidney function temporarily, but once the blood
supply is replenished, the kidneys usually return to normal.
Other kinds of acute kidney disease in children are
Hemolytic uremic syndrome. This rare disease affects mostly
children under 10 years of age and can result in kidney
failure. Eating foods contaminated by bacteria leads to an
infection in the digestive system, which in the first stages
causes vomiting and diarrhea. When these symptoms
subside, the child is still listless and pale. Poisons
produced by the bacteria can damage the kidneys, causing
acute kidney failure. Children with hemolytic uremic
syndrome may need blood transfusion or dialysis for a
short time. Most children, however, return to normal after a
few weeks. Only a small percentage of children (mostly
those who have severe acute kidney disease) will develop
chronic kidney disease.

 Nephrotic syndrome. A child with this syndrome
will urinate less often, so the water left in the
body causes swelling around the eyes, legs, and
belly. The small amount of urine the body makes
contains high levels of protein. Healthy kidneys
keep protein in the blood, but damaged kidneys
let it leak from the blood into the urine. Nephrotic
syndrome can usually be treated with prednisone
to stop protein leakage, and sometimes a diuretic
is used to help the child urinate and reduce the
swelling. Usually, the child can take smaller and
smaller doses of prednisone and eventually
return to normal with no lasting kidney damage.
This temporary condition is called minimal
change disease. Relapses are common but
usually respond to prednisone treatment.
Chronic Kidney Diseases

Unfortunately, the conditions that
lead to chronic kidney failure in
children cannot be easily fixed.
Often, the condition will develop so
slowly that it goes unnoticed until
the kidneys have been permanently
damaged. Treatment may slow down
the progression of some diseases,
but in many cases the child will
eventually need dialysis or
transplantation.
Chronic Kidney Diseases
 Birth defects. Some babies are born
without kidneys or with abnormally
formed kidneys. The kidney
abnormality is sometimes part of a
syndrome that affects many parts of
the body.
Agenesia
Aplasia
Duplication
Polycystosis
Dystopia
Hypoplasia
Chronic Kidney Diseases
 Blocked urine flow and reflux. If blockage
develops between the kidneys and the opening
where urine leaves the body, the urine can back
up and damage the kidney.
Chronic Kidney Diseases
 Hereditary diseases. In polycystic
kidney disease (PKD), children inherit
defective genes that cause the kidneys to
develop many cysts, sacs of fluid that
replace healthy tissue and keep the
kidneys from doing their job. In Alport
syndrome, the defective gene that causes
kidney disease may also cause hearing or
vision loss.
Chronic Kidney Diseases
 Glomerular diseases. Some diseases attack the
individual filtering units in the kidney. When
damaged, these filters—which are called
glomeruli—leak blood and protein into the
urine. If the damage to the glomeruli is severe,
kidney failure may develop.
Chronic Kidney Diseases
 Systemic diseases. Diabetes and lupus can affect many
parts of the body, including the kidneys in some people.
In lupus, the immune system becomes overactive and
attacks the body’s own tissues. Diabetes leads to high
levels of blood glucose that damage the glomeruli.
Diabetes is the leading cause of kidney failure in adults.
In children, however, diabetes is low on the list of causes
because it usually takes many years of high blood glucose
for the kidney disease of diabetes to develop. However,
an increasing number of children have type 2 diabetes,
which is usually associated with adults. As a result, we
From birth to age 4 years, birth defects
and hereditary diseases are by far the
leading causes of kidney failure.
Between ages 5 and 14 years, hereditary
diseases continue to be the most
common causes, followed closely by
glomerular diseases.
In the 15- to 19-year-old age group, glomerular
diseases are the leading cause, and hereditary
diseases become rarer.
Urinary tract infections (UTIs)
are a common, potentially serious, and (especially in young children) often
occult bacterial infection of childhood. During childhood, UTI occurs in
approximately 3-5% of girls and 1% of boys. Most of the UTIs in boys
occur in the first year of life, whereas the age of the first diagnosed UTI
in girls is highly variable. After 2 years of age, UTI in females exceeds
that in males by a factor of 10:1 (1). Uncircumcised males less than one
year old are more likely to be affected than circumcised males (2,3). The
prevalence of UTI in a febrile child 2-24 months of age, without other
source of infection, is 5% (4). After 6 years of age, and before the onset
of sexual activity, incidence of UTI falls dramatically in both sexes.
Urinary tract infections (UTIs)
Many factors may predispose a child to UTI, including
 abnormalities of the urinary tract such as vesicoureteral reflux
(VUR),

renal anomalies with hydronephrosis or obstruction,

neurogenic bladder,
 or nephrolithiasis;
 functional abnormalities such as constipation,

fecal incontinence,
 or incomplete bladder emptying;
 and environmental factors such as bubble baths, poor perineal
hygiene, pinworms, or sexual activity, including sexual abuse.
 Labial adhesions in girls and phimosis in boys also contribute to
an increased risk of UTI.
Megaloureter

The aetiology resembles that
of Hirsch-sprung's disease,
which often is associated. It
is assumed that faulty
parasympathetic innervation
leads to defective detrusor
function, bladder dilation and
reflux. Anatomical
obstruction has to be
excluded.
Megaloureter

Newborn with several
peculiar features Lowset, malformed ears and
heavy skinfolds under
the eyes are reminiscent
of Potter's face. He
developed urinary
symptoms.
Megaloureter
Retrograde pyelography

A dilated bladder, bilateral tortuous
megaloureters and right-sided
hydronephrosis were revealed.
NURSING THE CHILD WITH DISEASES OF
URINARY
SYSTEM
Any mistake can lead to development of renal
failure, which is one of the most dangerous
conditions.
Nursing care plan includes:
 accurate measurement and record of fluid intake
and output,
 daily weighting,
 measuring blood pressure,
 collecting specimens for laboratoryexaminations,
 administration of prescribed
medicines(antibiotics, diuretics, steroids, ect),
 strict control for the diet (provide restriction of
sodium, proteins, water, administer
supplementary vitamins and iron as ordered) and
 balance of rest and activity (maintain bed rest
initially if severely edematous).
Control edema

Weigh daily, measure abdominal girth at
umbilicus.
 Measure accurately intake and output. Test urine
for specific gravity, albumins.
 Take blood pressure.
 Prevent skin breakdown: provide meticulous skin
care, cleanse
and powder opposing skin surfaces several times
daily, separate skin
surfaces with soft cotton, support edematous
organs, such as scrotum,
cleanse edematous eyelids with warm saline
wipes.
Prevent further edema formation:
Provide salt-restricted diet.
 Limit fluids if odered.
 Administer diuretics and/or steroids
if prescribed.

Growth Failure in Children With Kidney Disease

If the kidneys are impaired, bones do
not get enough calcium either
because the kidneys fail to turn
vitamin D into calcitriol or because
they let too much phosphorus build
up in the blood. The excess
phosphorus draws calcium into the
blood and blocks it from getting to
the bones.

doctor may
recommend limiting
foods that are high in
phosphorus, like milk
and other dairy
products (except
cream cheese and
cottage cheese), meat,
fish, and poultry.
High-phosphorus
foods also include
some vegetables like
broccoli, peas, and
beans. A dietitian can
help learn to control
phosphorus intake by
measuring foods and
keeping track of their
phosphorus content.

The kidneys turn
vitamin D into an
active hormone called
calcitriol that helps
bones absorb the
right amount of
calcium from blood.
Children with chronic
kidney disease may
need to take a
synthetic form of
calcitriol or a similar
vitamin D hormone.
These supplements
may be administered
by injection or taken
orally in pill form.
 As the first step in filtration, blood is delivered
into the glomeruli by microscopic leaky blood
vessels called capillaries. Here, blood is filtered
of waste products and fluid while red blood cells,
proteins, and large molecules are retained in the
capillaries. In addition to wastes, some useful
substances are also filtered out. The filtrate
collects in a sac called Bowman's capsule and
drains into the tubule.
The tubules are the next step in the
filtration process.
 The tubules are lined with highly
functional cells which process the filtrate,
reabsorbing water and chemicals useful to
the body while secreting some additional
waste products into the tubule.
The kidneys also produce certain hormones :



Activate form of vitamin D (calcitriol or 1,25
dihydroxy-vitamin D), which regulates
absorption of calcium and phosphorus from
foods, promoting formation of strong bone.
Erythropoietin (EPO), which stimulates the
bone marrow to produce red blood cells.
Renin, which regulates blood volume and blood
pressure.
What is the difference between kidney failure and kidney
disease?




Kidney failure
Kidney failure occurs when the kidneys partly or
completely lose their ability to carry out normal
functions.
This is dangerous because water, waste, and toxic
substances build up that normally are removed from
the body by the kidneys.
It also causes other problems such as anemia, high
blood pressure, acidosis (excessive acidity of body
fluids), disorders of cholesterol and fatty acids, and
bone disease in the body by impairing hormone
production by the kidneys.
Stages of Chronic Kidney Disease
StageDescriptionGFR

mL/min/1.73m21Slight kidney damage with
normal or increased filtrationMore than 902Mild
decrease in kidney function60-893Moderate
decrease in kidney function30-594Severe
decrease in kidney function15-295Kidney failure
requiring dialysis or transplantationLess than 15
Chronic Kidney Disease Causes



Although chronic kidney disease sometimes results
from primary diseases of the kidneys themselves, the
major causes are diabetes and high blood pressure.
Type 1 and type 2 diabetes mellitus cause a condition
called diabetic nephropathy, which is the leading
cause of kidney disease in the United States.
High blood pressure (hypertension), if not controlled,
can damage the kidneys over time.

Glomerulonephritis is the inflammation and
damage of the filtration system of the kidneys
and can cause kidney failure. Postinfectious
conditions and lupus are among the many
causes of glomerulonephritis.

Polycystic kidney disease is an example of a
hereditary cause of chronic kidney disease
where i n both kidneys have multiple cysts.

Use of analgesics such as acetaminophen (Tylenol) and
ibuprofen (Motrin, Advil) regularly over long durations of time
can cause analgesic nephropathy, another cause of kidney disease.
Certain other medications can also damage the kidneys.

Clogging and hardening of the arteries (atherosclerosis) leading
to the kidneys causes a condition called ischemic nephropathy,
which is another cause of progressive kidney damage.
Obstruction of the flow of urine by stones, an enlarged
prostate, strictures (narrowings), or cancers may also cause
kidney disease.
Other causes of chronic kidney disease include HIV infection,
sickle cell disease, heroin abuse, amyloidosis, kidney stones,
chronic kidney infections, and certain cancers.


Chronic Kidney Disease Symptoms






Fatigue and weakness (from anemia or accumulation of waste
products in the body)
Loss of appetite, nausea and vomiting
Need to urinate frequently, especially at night
Swelling of the legs and puffiness around the eyes (fluid
retention)
Itching, easy bruising, and pale skin (from anemia)
Headaches, numbness in the feet or hands (peripheral
neuropathy), disturbed sleep, altered mental status
(encephalopathy from the accumulation of waste products or
uremic poisons), and restless legs syndrome





High blood pressure, chest pain due to
pericarditis (inflammation around the heart)
Shortness of breath from fluid in lungs
Bleeding (poor blood clotting)
Bone pain and fractures
Decreased sexual interest and erectile
dysfunction
Some signs and symptoms represent the possibility of a severe
complication of chronic kidney disease and warrant a visit to the nearest
hospital emergency department.







Change in level of consciousness - extreme
sleepiness or difficult to awaken
Fainting
Chest pain
Difficulty breathing
Severe nausea and vomiting
Severe bleeding (from any source)
Severe weakness
Exams and Tests

Urinalysis: Analysis of the urine affords
enormous insight into the function of the
kidneys. The first step in urinalysis is doing a
dipstick test. The dipstick has reagents that
check the urine for the presence of various
normal and abnormal constituents including
protein. Then, the urine is examined under a
microscope to look for red and white blood cells,
and the presence of casts and crystals (solids).

Only minimal quantities of albumin (protein)
are present in urine normally. A positive result
on a dipstick test for protein is abnormal. More
sensitive than a dipstick test for protein is a
laboratory estimation of the urine albumin
(protein) and creatinine in the urine. The ratio
of albumin (protein) and creatinine in the urine
provides a good estimate of albumin (protein)
excretion per day.
Twenty-four-hour urine tests:

This test requires you to collect all of your urine
for 24 consecutive hours. The urine may be
analyzed for protein and waste products (urea,
nitrogen, and creatinine). The presence of
protein in the urine indicates kidney damage.
The amount of creatinine and urea excreted in
the urine can be used to calculate the level of
kidney function and the glomerular filtration
rate (GFR).
Glomerular filtration rate (GFR):

The GFR is a standard means of expressing
overall kidney function. As kidney disease
progresses, GFR falls. The normal GFR is about
100-140 mL/min in men and 85-115 mL/min in
women. It decreases in most people with age.
The GFR may be calculated from the amount of
waste products in the 24-hour urine or by using
special markers administered intravenously
Blood tests

Creatinine and urea (BUN) in the blood:
Blood urea nitrogen and serum creatinine are
the most commonly used blood tests to screen
for, and monitor renal disease. Creatinine is a
breakdown product of normal muscle
breakdown. Urea is the waste product of
breakdown of protein. The level of these
substances rises in the blood as kidney function
worsens.
Electrolyte levels and acid-base balance:

Kidney dysfunction causes imbalances in
electrolytes, especially potassium, phosphorus,
and calcium. High potassium (hyperkalemia) is a
particular concern. The acid-base balance of the
blood is usually disrupted as well.

Decreased production of the active form of
vitamin D can cause low levels of calcium in the
blood. Inability to excrete phosphorus by failing
kidneys causes its levels in the blood to rise.
Testicular or ovarian hormone levels may also be
abnormal.
Blood cell counts:

Because kidney disease disrupts blood cell
production and shortens the survival of red cells,
the red blood cell count and hemoglobin may be
low (anemia). Some patients may also have iron
deficiency due to blood loss in their
gastrointestinal system. Other nutritional
deficiencies may also impair the production of
red cells.
Ultrasound:

Ultrasound is often used in the diagnosis of kidney
disease. An ultrasound is a noninvasive type of test. In
general, kidneys are shrunken in size in chronic kidney
disease, although they may be normal or even large in
size in cases caused by adult polycystic kidney disease,
diabetic nephropathy, and amyloidosis. Ultrasound may
also be used to diagnose the presence of urinary
obstruction, kidney stones and also to assess the blood
flow into the kidneys.
The rules of preparation of the patient for emergency
urographv:
On the eve in the evening to use a cleansing enema (not high
siphon).
 If possible, to eliminate the reception of medicinal remedies

On the eve to check the sensitivity of an organism to X-ray contrast
substance.

On the day of urography a patient should have mild
noncarbohydrate breakfast in the morning, 2-3 hours prior to the
beginning of urography, which that prevents derivation of gases
due to hungerness in the intestine.
Biopsy:

A sample of the kidney tissue (biopsy) is
sometimes required in cases in which the cause
of the kidney disease is unclear. Usually, a biopsy
can be collected with local anesthesia only by
introducing a needle through the skin into the
kidney. This is usually done as an outpatient
procedure, though some institutions may require
an overnight hospital stay.
Congenital problems of the urinary tract.


As a fetus develops in the womb, any part of the urinary tract
can grow to an abnormal size or in an abnormal shape or
position. One common congenital abnormality (an abnormality
that exists at birth) is duplication of the ureters, in which a
kidney has two ureters coming from it instead of one. This
defect occurs in about 1 out of every 125 births and can cause
the kidney to develop problems with repeated infections and
scarring over time.
Another congenital problem is horseshoe kidney, where the two
kidneys are fused (connected) into one arched kidney that usually
functions normally, but is more prone to develop problems later
in life. This condition is found in 1 out of every 500 births.
Glomerulonephritis

is an inflammation of the glomeruli, the parts of
the filtering units (nephrons) of the kidney that
contain a network of capillaries (tiny blood
vessels).

The most common form is post-streptococcal
glomerulonephritis, which usually occurs in
young children following a case of strep throat.
Most kids with this type of nephritis recover
fully, but a few can have permanent kidney
damage that eventually requires dialysis or a
kidney transplant.
High blood pressure (hypertension)

can result when the kidneys are impaired by
disease. The kidneys control blood pressure by
regulating the amount of salt in the body and by
producing the enzyme renin that, along with
other substances, controls the constriction of
muscle cells in the walls of the blood vessels.
Kidney (renal) failure

can be acute (sudden) or chronic (occurring over
time and usually long lasting or permanent). In
either form of kidney failure, the kidneys slow
down or stop filtering blood effectively, causing
waste products and toxic substances to build up
in the blood.
Acute kidney failure

bacterial infection, injury, shock, heart failure,
poisoning, or drug overdose.
Treatment

includes correcting the problem that led to the
failure and sometimes requires surgery or dialysis.
Dialysis

Dialysis involves using a machine or other
artificial device to remove the excess salts and
water and other wastes from the body when the
kidneys are unable to perform this function.
Chronic kidney failure

involves a deterioration of kidney function over
time. In children, it can result from acute kidney
failure that fails to improve, birth defects of the
kidney, chronic kidney diseases, repeated kidney
infections, or chronic severe high blood pressure.
If diagnosed early, chronic kidney failure in
children can be treated but usually not reversed.

The child will usually require a kidney transplant
at some point in the future.
Kidney stones

(or nephrolithiasis) result from the buildup of
crystallized salts and minerals such as calcium in
the urinary tract. Stones (also called calculi) can
also form after an infection.

If kidney stones are large enough to block the
kidney or ureter, they can cause severe
abdominal pain. But the stones usually pass
through the urinary tract on their own. In some
cases, they may need to be removed surgically.
Nephritis

Nephritis is any inflammation of the kidney. It
can be caused by infection, medications, an
autoimmune disease (such as lupus), or it may be
idiopathic (which means the exact cause may not
be known or understood). Nephritis is generally
detected by protein and blood in the urine.
Nephrotic syndrome

is a type of kidney disease that leads to loss of
protein in the urine and swelling of the face
(often the eyes) or body (often around the
genitals). It is most common in children younger
than 6 years old and is more prevalent in boys..

Nephrotic syndrome is often treated with
steroids
Urinary tract infections

(UTIs) are usually caused by intestinal bacteria, such as
E. coli, normally found in feces. These bacteria can
cause infections anywhere in the urinary tract, including
the kidneys. Most UTIs occur in the lower urinary tract,
in the bladder and urethra. UTIs occur in both boys
and girls. However, uncircumcised males are about 3 to
12 times more likely than circumcised males to develop
a UTI before age 1. Although uncircumcised males are
about 3 to 12 times more likely than circumcised males
to develop a UTI before age 1,

In school-age children, girls are more likely to
develop UTIs than boys; this may be because
girls have shorter urethras than boys.
Vesicoureteral reflux (VUR)

is a condition in which urine abnormally flows
backward (or refluxes) from the bladder into the ureters.
It may even reach the kidneys, where infection and
scarring can occur over time. VUR occurs in 1% of
children and tends to run in families. It's often detected
after a young child has a first urinary tract infection.
Most kids outgrow mild forms of VUR, but some can
develop permanent kidney damage and kidney failure
later in life.
Wilms' tumor

is the most common kidney cancer occurring in
children. It is diagnosed most commonly
between 2 and 5 years of age and affects males
and females equally.
How does the urinary system work?
Voiding

Urination, or voiding, is a complex activity. The
bladder is a balloon-like organ that lies in the
lowest part of the abdomen. The bladder stores
urine, then releases it through the urethra, the
canal that carries urine to the outside of the
body. Controlling this activity involves nerves,
muscles, the spinal cord, and the brain.
The bladder

The bladder is composed of two types of muscles: the
detrusor, a muscular sac that stores urine and squeezes
to empty; and the sphincter, a circular group of muscles
at the bottom or neck of the bladder that automatically
stay contracted to hold the urine in and automatically
relax when the detrusor contracts to let the urine into
the urethra. A third group of muscles below the
bladder (pelvic floor muscles) can contract to keep
urine back.
Infrequent Voiding

Infrequent voiding refers to a child’s voluntarily holding urine for prolonged intervals
small bladder capacity
structural problems
anxiety-causing events
pressure from a hard bowel movement (constipation)
drinks or foods that contain caffeine, which increases
urine output and may also cause spasms of the bladder muscle,
or other ingredients to which the child may have an allergic reaction,
such as chocolate or artificial coloring
Incontinence is also called enuresis




Primary enuresis is wetting in a person who has
never been dry for at least 6 months.
Secondary enuresis is wetting that begins after at
least 6 months of dryness.
Nocturnal enuresis is wetting that usually occurs
during sleep, also called nighttime incontinence.
Diurnal enuresis is wetting when awake, also
called daytime incontinence.
What is a UTI?
inary tract infection (UTI) develops when part of
urinary system becomes infected, usually by bacteria.
eria can enter your urinary system through the
hra or, more rarely, through your bloodstream.
There are two different types of UTI:


Lower UTI: this is an infection of the lower
part of the urinary tract, which includes the
bladder and the urethra. An infection of the
bladder is called cystitis and an infection of the
urethra is known as urethritis.
Upper UTI: this is an infection of the upper
part of the urinary tract, which includes the
kidneys and the ureters. An infection of the
kidneys is called pyelonephritis.
Maintain the diet; the major attention should be
taken to the patients in the period of unsalted
diet.
At the indication of the doctor careful
examine of the intake and
excreted fluid.
First aid
at ischuria










Put a warm water bag on the over the lower part of the abdomen.
At the absence of contraindication (high temperature, cardiovascular
pathology, etc.) it is possible to put the child into a warm bath.
For some children the reflex on urination can be developed at the
sound of water current from the tap.
Sometimes it is enough to leave the patient alone, and he will urinate
The patient may not be able to urinate in horizontal position - it is
necessary to make such a child sit and the urinary bladder will be
emptied.
Sometimes, it is effective for urination to drain some warm water on
the external sexual oraans of girls or put the penis of bovs into warm water.
Inform the doctor who will do catheterization of the urinary badder, if
necessary.
Remindable point: watch if the child urinated or not, how many times a day and what
quantity of urine he/she excreted.
At renal colic
accompanying by very strong, intolerant pains in
the lumbar region:
 A hot water bag on pain area.
 The hot bath (at the absence of
contraindications) - the temperature of water
should be more than 0 C
 Call the doctor.