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Pediatric Physiological Immaturity

The pediatric GU system differs significantly from adults. Children have a slower Glomerular Filtration Rate (GFR) and less efficient urinary concentration, making them highly susceptible to dehydration and fluid overload.

• Anatomy: The female urethra is shorter, increasing Urinary Tract Infection (UTI) risk. The kidneys are less protected by fat/ribs, increasing injury risk.

• Assessment Priority: Weight is the best indicator of fluid status. Assessment focuses on hydration (I&O, specific gravity), blood pressure (critical in renal disease), and edema.

Major Structural Disorders

• Hypospadias/Epispadias: Displacement of the urethral opening. Key Intervention: Do not circumcise the infant; the foreskin is reserved for surgical reconstruction. Post-op care involves maintaining stents and a double-diapering technique to keep the site clean.

• Bladder Exstrophy: The bladder is exposed externally. Care focuses on preventing infection and skin breakdown. Note: These children are at high risk for latex allergies.

• Vesicoureteral Reflux (VUR): Urine backflows from the bladder to ureters, causing renal scarring. The goal is preventing pyelonephritis via prophylactic antibiotics or surgical reimplantation.

Renal Disorders: The "Big Three" Differentiators

Distinguishing these acquired disorders is critical for nursing management:

1. Nephrotic Syndrome (The "Leaky" Filter)

• Pathology: Increased glomerular permeability leads to massive loss of protein.

• Key Symptoms: Severe edema (anasarca), massive proteinuria, hypoalbuminemia, and hyperlipidemia.

• Management: Corticosteroids (prednisone) are the gold standard. Monitor for infection (due to steroid immunosuppression) and skin breakdown.

2. Acute Poststreptococcal Glomerulonephritis (APSGN)

• Pathology: Immune complex injury following a Group A Strep infection.

• Key Symptoms: Gross hematuria (tea/cola-colored urine), Hypertension, and mild edema.

• Management: No specific cure; supportive care focuses on managing hypertension and fluid balance.

3. Hemolytic Uremic Syndrome (HUS)

• Pathology: Often follows E. coli diarrheal illness.

• The Triad: Hemolytic anemia, Thrombocytopenia (low platelets), and Acute Kidney Injury (AKI).

• Management: Dialysis for renal failure; monitor for bleeding and fluid overload.

Renal Failure & Emergencies

• Acute Kidney Injury (AKI): Primary danger is Hyperkalemia (muscle weakness, irregular pulse). Treatment restores fluid balance and reduces potassium.

• Chronic/ESKD: Requires dialysis (Peritoneal allows for more independence) or transplant. Rejection is the major transplant risk.

• Reproductive Emergency: Testicular Torsion (twisted spermatic cord) causes sudden severe pain and is a surgical emergency requiring immediate intervention to prevent necrosis