Final — Genitourinary is new; the rest is comprehensiveWeek 13
📚 Reading: UTI, VUR, HUS, AGN, nephrotic syndrome
NephrOtic = prOtein. NephrItic = blood and hypertensIon.
Daily weight is the key assessment in both.
💡 The one idea
Two childhood kidney diseases look similar and are opposites.Nephrotic leaks protein. Nephritic leaks blood.
Nephrotic syndrome
Acute glomerulonephritis
Urine
Massive protein, frothy
Blood — tea/cola colored
Edema
Severe, generalized, periorbital in the morning
Mild, periorbital
Blood pressure
Normal or low
HIGH
Serum albumin
Low
Normal
Preceded by
Often idiopathic
Strep infection 1–3 weeks before
Treatment
Steroids, albumin, low salt
Support, BP control, fluid limits
🖼️ Nephrotic syndrome versus acute glomerulonephritis.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ The one-line separator
“NephrOtic = prOtein. NephrItic = blood and hypertensIon.”
If the child had a sore throat or skin infection a couple of weeks ago and now has
cola-colored urine and high blood pressure, it is glomerulonephritis.
🚨 Daily weight is the assessment
Weigh at the same time, on the same scale, in the same clothing. In nephrotic syndrome
it tracks the edema and the response to steroids better than anything else.
Also measure abdominal girth for ascites, and monitor for infection — these
children lose immunoglobulins in the urine and are on steroids.
✅ UTI in children
Infants present non-specifically: fever, poor feeding, vomiting, irritability —
not dysuria. A febrile infant with no obvious source needs urine tested.
Teaching: wipe front to back, cotton underwear, avoid bubble baths, empty the bladder
fully and often, and plenty of fluids.
Recurrent UTIs prompt investigation for vesicoureteral reflux, because repeated
pyelonephritis scars the kidney.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Kidney damage predictably produces hypertension (renin) and anemia (erythropoietin). Elevated BP in a child should point you at the kidneys first. Renal function is not mature until about age 2.
NSAIDs are nephrotoxic — withhold if the child is dehydrated or renal function is unknown.
Hypospadias: urethral meatus on the ventral surface. Circumcision must be delayed because the foreskin is needed for the repair. Catheter stays 5–10 days; oxybutynin for spasms.
VUR: suspect it with recurrent UTIs. VCUG is the gold standard. Post-op the goal urine output is >1.5 mL/kg/hr to flush the repair. Pink-tinged urine is expected; clots are not.
Bladder exstrophy: position supine, never prone, and cover the bladder with a transparent non-adherent dressing. The deliberate mirror image of myelomeningocele.
Show 5 moreHide these 5
Enuresis: rule out UTI, new diabetes and psychosocial stress before calling it primary. Escalate from fluid timing and bed alarms to desmopressin last.
UTI: girls are higher risk from a shorter urethra. Complete the full antibiotic course. Fever plus flank or CVA tenderness suggests pyelonephritis.
HUS: usually follows E. coli Shiga toxin. Triad = anemia, acute kidney injury, thrombocytopenia. Antibiotics are CONTRAINDICATED — they increase toxin release.
AGN: post-strep, abrupt onset, tea- or cola-colored urine, marked hypertension with encephalopathy risk, mild edema. ASO titer confirms.
Nephrotic syndrome: idiopathic, insidious, frothy urine with massive proteinuria, low albumin, hyperlipidemia, severe generalized edema. Corticosteroids are the mainstay and must be tapered, never stopped abruptly.
Show 1 moreHide these 1
Renal failure: hyperkalemia is the emergency because it drives arrhythmias. Diet is low potassium, low sodium, low protein, high carbohydrate. Daily weights are the best fluid indicator.
Acute glomerulonephritis is a brief inflammation lasting about 1–2 weeks. Complement C3 falls first and returns to normal by 6–8 weeks — that recovery curve is how you know it is resolving.
Admission is not automatic. If her pressure sits in range and she is still making enough urine, she can be followed at home — the two numbers that decide it are blood pressure and output.
Glomerulonephritis versus nephrotic syndrome: glomerulonephritis brings hypertension and blood in the urine; in nephrotic syndrome the pressure is normal or even slightly low, and hypertension is a rare finding.
Nephrotic syndrome comes in three forms: primary (direct glomerular injury), secondary (systemic disease), and congenital.
Keep the child and the household away from anyone who is ill — these children are on steroids and are being immunosuppressed.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 46 (renal and urinary) · ch. 47 (reproductive).
Glomerulonephritis brings hypertension and red cell casts; nephrotic syndrome brings heavy proteinuria with a normal or low pressure. That contrast is the exam question.
⚠️ Exam traps
AGN vs nephrotic is the flagship comparison: profuse hematuria with marked hypertension and mild edema, versus rare hematuria with extreme edema and marked hyperlipidemia.
Both are oliguric with high specific gravity, so those findings do not distinguish them.
Antibiotics help AGN and harm HUS.
🧠 Mind maps 3
One per disorder, built from the structure of your ATI chapter.
Enuresis and Urinary Tract Infections
🎯 Who gets it
Enuresis: family history, twin sibling, disorders causing bladder dysfunction, male sex, emotional events such as a new sibling or divorce, behavioral disorders
UTI: start of toilet training, uncircumcised penis, female sex because the urethra sits close to the rectum
UTI: bubble baths, sexual activity, catheterization
👀 What you see
History of toilet training, voiding behavior, and bowel patterns; chronic or acute illness such as UTI, diabetes mellitus, sickle cell disease, or neurologic deficits; evening fluid intake
Restlessness, urinary frequency and urgency
UTI under 2 years is nonspecific — newborns show jaundice, tachypnea, cyanosis, hypothermia, or fever; infants show poor feeding, vomiting, diarrhea, irritability, lethargy, frequent urination, fever
UTI over 2 years: enuresis, frequency, dysuria, hematuria, chills, malodorous urine, abdominal or flank pain
🧪 What confirms it
Urinalysis with culture and sensitivity
Sterile catheterization and suprapubic aspiration are the most accurate collection methods under 2 years
Clean-catch sample for children able to cooperate
Ultrasonography and voiding cystourethrogram to identify anatomic defects
🩺 What you do
Assess the child's self-esteem, coping strategies, and support systems, and the family's coping and access to support groups
Have the child void before bedtime and restrict fluids for at least 2 hr before bed
Avoid caffeinated drinks in the afternoon
Use positive reinforcement and never punish, scold, or tease after an accident
💊 Drugs
Desmopressin acetate, an antidiuretic hormone, reduces urine volume — give at bedtime, restrict fluids after dinner, and watch for headache and nausea
Imipramine hydrochloride, a tricyclic antidepressant, inhibits urination — give 1 hr before bedtime with food to reduce gastric effects, monitor for low mood and suicidal thoughts, and avoid sun exposure
Oxybutynin chloride, an anticholinergic, reduces bladder contractions — watch for dry mouth and constipation
UTI antibiotics guided by culture and sensitivity — penicillins, sulfonamides, cephalosporins, nitrofurantoin, given orally or IV depending on severity, with monitoring for allergic response
💬 What you teach
Finish the entire antibiotic course even after symptoms resolve
Take medications exactly as prescribed and report adverse effects rather than stopping on your own
⚠️ What goes wrong
Emotional problems — social isolation, fears, altered body image, and low self-esteem
Urosepsis — monitor for UTI findings and reinforce prevention, early recognition, and treatment
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Structural Disorders of the Genitourinary Tract and Reproductive System
🎯 Who gets it
Can have a genetic link
👀 What you see
Obstructive uropathy: structural or functional blockage in the urinary system
Hydronephrosis with dilated renal pelvis and calyces when the ureteropelvic junction is obstructed, sometimes seen on fetal ultrasound; partial obstruction may go undetected
Oligohydramnios prenatally can signal reduced fetal kidney function or obstruction
Urinary tract infections, secondary hypertension, renal colic with severe low back pain, enuresis, urinary urgency, urge incontinence
🩺 What you do
Focus care on education and support for child and family
Assess the family's perception of the defect, their support, and their coping
Help caregivers find ways to protect the child's positive self-image and promote healthy growth and development
Bladder exstrophy: cover the exposed bladder with a transparent plastic dressing to keep it moist, prepare for immediate surgery, and consult an enterostomal nurse if surgery is delayed
⚠️ What goes wrong
Infection — watch for fever, skin inflammation, foul or cloudy urine, and urinary frequency, and report findings immediately
Emotional problems including poor self-esteem, altered body image, social isolation, and fears — listen to concerns, correct misperceptions, use play therapy for toddlers and preschoolers, encourage peer contact for older children, and consider support groups
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Kidney Disorders
🎯 Who gets it
Acute glomerulonephritis: recent streptococcal skin or throat infection
Minimal change nephrotic syndrome: highest incidence in preschoolers, cause unknown but may follow infection, neoplasm, allergy, or drug exposure
Prerenal AKI: dehydration from diarrhea or persistent vomiting, diabetes mellitus, surgical shock, trauma including burns, accidental poisoning, prolonged anesthesia
Glomerulonephritis: vague complaints of headache, abdominal pain, and dysuria, periorbital edema, facial edema worst in the morning that spreads to extremities and abdomen through the day, mild to severe hypertension, low-grade fever, vomiting
Encephalopathy with headache, irritability, and seizures
Nephrotic syndrome: weight gain over days to weeks, facial and periorbital edema that decreases through the day, ascites, edema of lower extremities and genitalia, dark frothy urine
🧪 What confirms it
Throat culture for streptococcus, usually negative by the time of diagnosis
Urinalysis: hematuria, proteinuria, raised specific gravity, and smoky or tea-colored urine
Kidney function: elevated BUN and creatinine with decreased glomerular filtration rate
Blood studies: hypoalbuminemia, anemia with decreased hemoglobin and hematocrit, elevated erythrocyte sedimentation rate
🩺 What you do
Home management with close follow-up is appropriate when blood pressure is normal and urine output is adequate
Monitor intake and output and the volume and character of urine
Weigh daily on the same scale in the same amount of clothing
Monitor vital signs and neurologic status, watching for behavior change in children with edema, hypertension, and gross hematuria, and institute seizure precautions if indicated
💊 Drugs
Prednisone for nephrotic syndrome — 2 mg/kg/day for 4 weeks, then 1.5 mg/kg every other day for 4 weeks
Furosemide and other diuretics to remove accumulated fluid and manage hypervolemia; not useful in severe kidney failure; encourage potassium-rich foods and monitor electrolytes for hypokalemia
Antihypertensives to control blood pressure — warn about dizziness
25% albumin as a plasma expander raises plasma volume and reduces severe edema — give per protocol and watch for anaphylaxis
💬 What you teach
Corticosteroids increase appetite and cause weight gain, especially facial, along with mood swings, and raise infection risk
Avoid large crowds and people who are ill, and use frequent hand hygiene
Keep immunizations current including pneumococcal, but use caution with live vaccines while on steroids
⚠️ What goes wrong
Hypertensive encephalopathy
Circulatory overload
Acute kidney injury
Infection and sepsis, with steroid therapy adding risk — monitor closely for signs of infection
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 2
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
ATI Active Learning Template — System DisorderEnuresis and Urinary Tract Infections
Filled from ATI chapter 24, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Enuresis is unintentional urination past the age at which bladder control is expected. It is diagnosed when inappropriate daytime or nighttime voiding occurs at least twice weekly for at least 3 consecutive months in a child of developmental or chronologic age 5 years or older, after other causes such as medication effects and medical conditions are excluded. Primary enuresis means the child has never had an extended dry period; secondary enuresis means wetting resumed after control was established. A urinary tract infection is infection of any part of the urinary tract.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Explain that enuresis is not laziness or defiance, and that punishment makes it worse and last longer.
Most primary nocturnal enuresis resolves without treatment — reassurance is a genuine intervention.
Regular toileting, adequate daytime fluids, and less in the evening.
Treat constipation — it is a very common and very treatable cause of wetting.
Front-to-back wiping; avoid bubble baths and tight synthetic underwear.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Enuresis: family history, twin sibling, disorders causing bladder dysfunction, male sex, emotional events such as a new sibling or divorce, behavioral disorders
UTI: start of toilet training, uncircumcised penis, female sex because the urethra sits close to the rectum
UTI: bubble baths, sexual activity, catheterization
Assessment — Expected Findings
History of toilet training, voiding behavior, and bowel patterns; chronic or acute illness such as UTI, diabetes mellitus, sickle cell disease, or neurologic deficits; evening fluid intake
Restlessness, urinary frequency and urgency
UTI under 2 years is nonspecific — newborns show jaundice, tachypnea, cyanosis, hypothermia, or fever; infants show poor feeding, vomiting, diarrhea, irritability, lethargy, frequent urination, fever
UTI over 2 years: enuresis, frequency, dysuria, hematuria, chills, malodorous urine, abdominal or flank pain
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Urinalysis with culture and sensitivity
Sterile catheterization and suprapubic aspiration are the most accurate collection methods under 2 years
Clean-catch sample for children able to cooperate
Diagnostic Procedures
Ultrasonography and voiding cystourethrogram to identify anatomic defects
Functional bladder capacity screening — the child holds urine as long as possible then voids into a container and the volume is measured
Provider physical exam to rule out physical causes of enuresis, plus a record of the enuresis pattern
Teach the child and family about the test, prepare for catheterization if needed, and monitor afterward per protocol
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Assess the child's self-esteem, coping strategies, and support systems, and the family's coping and access to support groups
Have the child void before bedtime and restrict fluids for at least 2 hr before bed
Avoid caffeinated drinks in the afternoon
Use positive reinforcement and never punish, scold, or tease after an accident
Keep a calendar of wet and dry nights and let the child help change linens and clothing
Keep stools regular, soft, and formed
Encourage frequent voiding and adequate daytime fluids for UTI
Behavioral therapy is first-line: reward system for dry nights, Kegel/pelvic floor exercises for daytime enuresis to build bladder tone, and retention control where the child drinks a large volume and delays voiding to stretch the bladder
Conditioning therapy uses a urine sensor alarm — a padded moisture sensor in the undergarment buzzes to wake the child when wet
Medications
Desmopressin acetate, an antidiuretic hormone, reduces urine volume — give at bedtime, restrict fluids after dinner, and watch for headache and nausea
Imipramine hydrochloride, a tricyclic antidepressant, inhibits urination — give 1 hr before bedtime with food to reduce gastric effects, monitor for low mood and suicidal thoughts, and avoid sun exposure
Oxybutynin chloride, an anticholinergic, reduces bladder contractions — watch for dry mouth and constipation
UTI antibiotics guided by culture and sensitivity — penicillins, sulfonamides, cephalosporins, nitrofurantoin, given orally or IV depending on severity, with monitoring for allergic response
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Enuresis alarm — the most effective long-term treatment, though it takes weeks and family commitment.
Motivational systems and a star chart for dry nights; never a penalty for wet ones.
Desmopressin for short-term cover, such as a sleepover or school trip.
Bladder training and timed voiding for daytime wetting.
ATI Active Learning Template — System DisorderStructural Disorders of the Genitourinary Tract and Reproductive System
Filled from ATI chapter 25, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
A range of structural defects present at birth can disturb genitourinary and reproductive function. Because children become aware of and curious about genital appearance, function, and sex differences between 3 and 6 years, repair is ideally completed before that period.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Newborn examination checks for undescended testes, hypospadias and ambiguous genitalia.
Circumcision is deferred in hypospadias — the foreskin is needed for the repair.
Teach that cryptorchidism raises the lifetime risk of testicular cancer even after correction, so self-examination matters later.
Prompt treatment of urinary infection to protect the kidneys.
Teach parents not to force a non-retractile foreskin back — it is normal in young boys and forcing causes scarring.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Can have a genetic link
Assessment — Expected Findings
Obstructive uropathy: structural or functional blockage in the urinary system
Hydronephrosis with dilated renal pelvis and calyces when the ureteropelvic junction is obstructed, sometimes seen on fetal ultrasound; partial obstruction may go undetected
Oligohydramnios prenatally can signal reduced fetal kidney function or obstruction
Urinary tract infections, secondary hypertension, renal colic with severe low back pain, enuresis, urinary urgency, urge incontinence
Chordee: ventral curvature of the penis
Hypospadias: urethral meatus on the ventral penile shaft, below or behind the glans, or at the perineal/scrotal junction, often with chordee
Epispadias: urethral meatus open on the dorsal surface — in males the urethra opens on the dorsum with possible bladder exstrophy, in females the urethral opening is wide
Bladder exstrophy: posterior bladder everted through the anterior bladder and lower abdominal wall, exposing bladder, urethra, and ureteral orifices suprapubically
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Urinalysis and culture — collected by catheter or suprapubic aspiration in the non-toilet-trained; a bag specimen is unreliable.
Serum creatinine and electrolytes to assess renal function.
CBC and inflammatory markers where pyelonephritis is suspected.
Karyotype and hormone studies for ambiguous genitalia.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Renal and bladder ultrasound — the usual first imaging.
Voiding cystourethrogram for vesicoureteral reflux — it is invasive and needs preparation and analgesia.
Nuclear renal scan for scarring and differential function.
Examination for a palpable testis in the inguinal canal.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Focus care on education and support for child and family
Assess the family's perception of the defect, their support, and their coping
Help caregivers find ways to protect the child's positive self-image and promote healthy growth and development
Bladder exstrophy: cover the exposed bladder with a transparent plastic dressing to keep it moist, prepare for immediate surgery, and consult an enterostomal nurse if surgery is delayed
Phimosis hygiene: clean externally during routine bathing and never forcibly retract the foreskin
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Antibiotics for acute urinary infection, guided by culture.
Prophylactic antibiotics for significant reflux, to protect the kidneys while it is outgrown.
Analgesia after surgical repair; anticholinergics for bladder spasm.
Hormone therapy in specific disorders of sexual development, directed by endocrinology.
Therapeutic Procedures
Obstructive uropathy: urinary diversion around the obstruction with a ureteral stent, cutaneous ureterostomy tubes, or nephrostomy tubes
Chordee: surgical release of the fibrous band
Hypospadias and epispadias: surgical repair at 6-18 months of age
Bladder exstrophy: surgical repair immediately or within 3 months, with later reconstructive surgery for genital defects
Phimosis: topical steroids or circumcision
Cryptorchidism: orchiopexy between 6 and 18 months
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
After hypospadias repair: protect the stent or catheter, expect blood-tinged urine, double-diaper technique, no straddle toys.
After orchiopexy: no straddling or rough play for the period advised; watch the incision.
Report: fever, no urine output, a wound that opens or drains, or increasing pain.
Explain that surgery for undescended testis preserves fertility and makes future examination possible — not that it removes all risk.
Teach testicular self-examination when the boy is old enough.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Pediatric urologist for surgical management.
Nephrology where reflux has caused scarring or function is impaired.
Endocrinology and genetics for disorders of sexual development.
Child life — genital procedures are particularly distressing and need careful preparation.
Psychology for older children facing repeated genital surgery.
⚠️ What goes wrongComplications
Complications
Infection — watch for fever, skin inflammation, foul or cloudy urine, and urinary frequency, and report findings immediately
Emotional problems including poor self-esteem, altered body image, social isolation, and fears — listen to concerns, correct misperceptions, use play therapy for toddlers and preschoolers, encourage peer contact for older children, and consider support groups
📋 Kidney Disorders6 parts
ATI Active Learning Template — System DisorderKidney Disorders
Filled from ATI chapter 26, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers acute glomerulonephritis, nephrotic syndrome, hemolytic uremic syndrome, acute kidney injury, and chronic kidney disease. Acute glomerulonephritis is benign glomerular inflammation with intravascular coagulation lasting about 1-2 weeks and featuring oliguria, edema, hypertension with circulatory congestion, proteinuria, and hematuria; the post-streptococcal form is an antibody-antigen reaction to certain group A beta-hemolytic strep strains, most often in school-age children. In nephrotic syndrome an altered glomerular membrane lets protein, especially albumin, escape into the urine, lowering plasma osmotic pressure and producing proteinuria, hypoalbuminemia, hyperlipidemia, and edema; it may be primary, secondary to systemic illness, or congenital, and is classified as minimal change (most common, with scant glomerular scarring), focal glomerulosclerosis, or membranoproliferative. Acute kidney injury is the usually reversible inability to excrete waste, concentrate urine, and conserve electrolytes, classified as prerenal (most common), intrarenal, or postrenal.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Treat urinary infection promptly and investigate recurrent infection — scarring is silent and permanent.
Teach front-to-back wiping, adequate fluids, and not holding urine.
Monitor blood pressure at every visit — hypertension is often the first sign of kidney disease in a child.
Avoid nephrotoxic drugs where possible; check dosing in reduced renal function.
After streptococcal infection, watch for dark urine and puffiness — post-streptococcal glomerulonephritis.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Acute glomerulonephritis: recent streptococcal skin or throat infection
Minimal change nephrotic syndrome: highest incidence in preschoolers, cause unknown but may follow infection, neoplasm, allergy, or drug exposure
Prerenal AKI: dehydration from diarrhea or persistent vomiting, diabetes mellitus, surgical shock, trauma including burns, accidental poisoning, prolonged anesthesia
Glomerulonephritis: vague complaints of headache, abdominal pain, and dysuria, periorbital edema, facial edema worst in the morning that spreads to extremities and abdomen through the day, mild to severe hypertension, low-grade fever, vomiting
Encephalopathy with headache, irritability, and seizures
Nephrotic syndrome: weight gain over days to weeks, facial and periorbital edema that decreases through the day, ascites, edema of lower extremities and genitalia, dark frothy urine
Nephrotic syndrome: Muehrcke lines on the fingernails (white lines parallel to the lunula), pale skin, diarrhea, dyspnea
Chronic kidney disease: loss of energy, fatigue on exertion, intermittent hypertension, delayed growth, nausea and vomiting, reduced interest in activities
CKD: changed urine output with compensatory increase in fluid intake, uremic breath odor, headache, muscle cramps, weight loss, facial puffiness, malaise, bone or joint pain, dry itchy skin, easy bruising
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Throat culture for streptococcus, usually negative by the time of diagnosis
Urinalysis: hematuria, proteinuria, raised specific gravity, and smoky or tea-colored urine
Kidney function: elevated BUN and creatinine with decreased glomerular filtration rate
Blood studies: hypoalbuminemia, anemia with decreased hemoglobin and hematocrit, elevated erythrocyte sedimentation rate
Positive antistreptolysin O titer, with antihyaluronidase and antideoxyribonuclease testing for prior strep infection
Diagnostic Procedures
Kidney biopsy shows damage to the epithelial cells lining the basement membrane
MRI shows glomerular scarring; ultrasound and MRI evaluate kidney function
Chest x-ray to evaluate cardiopulmonary status — heart enlargement, pulmonary congestion, pleural effusion
ECG to detect dysrhythmias from electrolyte imbalance
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Home management with close follow-up is appropriate when blood pressure is normal and urine output is adequate
Monitor intake and output and the volume and character of urine
Weigh daily on the same scale in the same amount of clothing
Monitor vital signs and neurologic status, watching for behavior change in children with edema, hypertension, and gross hematuria, and institute seizure precautions if indicated
Encourage adequate nutrition — a regular diet is tolerated in mild cases
Restrict sodium and fluid as ordered, restrict high-potassium foods during oliguria, and restrict protein with severe azotemia
Limit processed foods and keep calories adequate to limit tissue catabolism, metabolic acidosis, hyperkalemia, and uremia
Prevent fluid overload when nutrition is given intravenously
Medications
Prednisone for nephrotic syndrome — 2 mg/kg/day for 4 weeks, then 1.5 mg/kg every other day for 4 weeks
Furosemide and other diuretics to remove accumulated fluid and manage hypervolemia; not useful in severe kidney failure; encourage potassium-rich foods and monitor electrolytes for hypokalemia
Antihypertensives to control blood pressure — warn about dizziness
25% albumin as a plasma expander raises plasma volume and reduces severe edema — give per protocol and watch for anaphylaxis
Cyclophosphamide for children who cannot tolerate prednisone, who relapse repeatedly, or to induce remission — monitor for leukopenia
Acute hyperkalemia: IV calcium gluconate over 2-5 min with continuous ECG monitoring; IV sodium bicarbonate raises pH and shifts potassium into cells; IV glucose with insulin drives potassium into cells
Therapeutic Procedures
Hemodialysis or peritoneal dialysis for persistent oliguria, severe hyperkalemia, uremic syndrome, or hypervolemia
Hemofiltration or ultrafiltration to remove excess waste products from the blood
Kidney transplantation for stage 5 chronic kidney disease using a kidney from a parent, grandparent, sibling, or other donor
💬 Around the patientClient Education · Interprofessional Care
Client Education
Corticosteroids increase appetite and cause weight gain, especially facial, along with mood swings, and raise infection risk
Avoid large crowds and people who are ill, and use frequent hand hygiene
Keep immunizations current including pneumococcal, but use caution with live vaccines while on steroids
Monitor blood pressure, daily weight, and urine protein at home and report worsening findings, which signal relapse
Complete the full antibiotic course even if the child improves, and contact the provider for any sign of infection
Allow adequate rest and keep follow-up appointments to monitor response to therapy
Encourage the child to talk about body image concerns
Interprofessional Care
Dietary consult, with teaching for the child on dietary management
Teach caregivers to monitor blood pressure and daily weight and to give diuretics and antihypertensives, including adverse effects
Pediatric nephrologist manages the condition, with dietitian, pharmacist, and nurse case manager
Social worker, case manager, school counselor, and school nurse address emotional support, school needs, and caregiver financial strain
⚠️ What goes wrongComplications
Complications
Hypertensive encephalopathy
Circulatory overload
Acute kidney injury
Infection and sepsis, with steroid therapy adding risk — monitor closely for signs of infection
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Kidney damage predictably produces hypertension (renin) and anemia (erythropoietin). Elevated BP in a child should point you at the kidneys first. Renal function is not mature until about age 2.
Hypospadias: urethral meatus on the ventral surface. Circumcision must be delayed because the foreskin is needed for the repair. Catheter stays 5–10 days; oxybutynin for spasms.
VUR: suspect it with recurrent UTIs. VCUG is the gold standard. Post-op the goal urine output is >1.5 mL/kg/hr to flush the repair. Pink-tinged urine is expected; clots are not.
Bladder exstrophy: position supine, never prone, and cover the bladder with a transparent non-adherent dressing. The deliberate mirror image of myelomeningocele.
HUS: usually follows E. coli Shiga toxin. Triad = anemia, acute kidney injury, thrombocytopenia. Antibiotics are CONTRAINDICATED — they increase toxin release.
Nephrotic syndrome: idiopathic, insidious, frothy urine with massive proteinuria, low albumin, hyperlipidemia, severe generalized edema. Corticosteroids are the mainstay and must be tapered, never stopped abruptly.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
