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 bean-shaped 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 1. Renal pyramid 2. Efferent artery  2. Efferent artery  3. Renal artery 3. Renal artery 4. Renal vein 4. Renal vein 5. Renal hylum 5. Renal hylum 6. Renal pelvis 6. Renal pelvis 7. Ureter 7. Ureter 8. Minor calyx 8. Minor calyx 9. Renal capsule 9. Renal capsule 10. Inferior renal capsule 10. Inferior renal capsule 11. Superior renal capsule 11. Superior renal capsule 12. Afferent vein  12. Afferent vein  13. Nephron 13. Nephron 14. Minor calyx 14. Minor calyx 15. Major calyx 15. Major calyx 16. Renal papilla 16. Renal papilla 17. Renal column 17. Renal column

Renal structure and physiologyRenal 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

theglomerulus, which is joined successively to the proximalconvoluted tubule,

Henle's loop, the distal convoluted tubule, the straight or collecting- duct.

Fibrous system of renalFibrous system of renal

Fibrous connective tissue

(lig.hepatorenale, lig. lienorenale, lig. duodenorenale)Renal vessels

Adipose tissueRenal fascia

Renal functionRenal function

Maintaining the electrical, chemical, concentration and acid-basebalances and the integrity and volume of body fluids at a constant level.

Elimination of metabolic by-products and unessential chemicalsdissolved in water (desintoxication).

The production of certain humoral substances:

Humoral substances:Humoral substances:

erythropoietic stimulating factor (ESF, or erythrogenin), whichacts on a plasma globulin to form erythropoietin;

renin, which is secreted by the kidneys in response to reducedblood volume, decreased blood pressure, or increased secretionof catecholamines;

renin stimulates the production of angiotensins, which producearteriolar constriction and an elevation of blood pressureand stimulate the production of aldosterone by the adrenalcortex.

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 fromthe 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 Kidneys play an important part in a child's growth and health.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 The peculiarities of kidney function in early infancyinfancy Glomerular filtration rate is low and does not reach adult values until

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 The peculiarities of kidney function in early infancyinfancy 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.

Newborn infants are unable to excrete a water load at rates of older persons.

The peculiarities of kidney function in early The peculiarities of kidney function in early infancyinfancy

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 The peculiarities of kidney function in early infancyinfancy 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 Anatomo- physiological perculiarities of urinary systemperculiarities 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 pelvisRenal 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.

UretersUreters

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, urethraUrethral canal, urethra

- Is more wide, short in children under 3 years

- external urethral meatus is opened in girl 3 yeas

Urinary bladderUrinary 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 channelsKidney channels

More shorts, has small diameter than in adult especially in the peripheral parts of the kidney

Capacity of the urinary bladder Capacity of the urinary bladder

Newborn 30ml

1 year 35-50 ml

1-3year 50-90 ml

3-5 year 100-150ml

5-9 year 200ml

9-12 year 200-300 ml

till 400 ml

Morphological peculiaritiesMorphological 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 Glomerular filtration (filtrative function is more lower)function is more lower)- poor reabsorbtive function- poor water pass function- Small ability to concentrate urine- The physiological urine acid- infarction

of kidney in newborns- Physiological anuria in newborn- Great frequency at urination after 3-5

days of life.

Localization of kidney.Localization of kidney.

Newborn – in the level I - V thoracic vertebras.

Older children - X thoracic and IV lumbal vertebras.

Length of the ureterLength 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 canalUrethral canal

Short urethraA little mucous and elastic tissue

Wide urethra in a girl

Daily diuresisDaily 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 urinationVolume of urination

Newborn – 10-15 ml6 month – 30 ml1 year – 60 ml

3-5 years – 90-100 ml7-8 years – 150 ml

10-12 years – 250 ml

Specific gravity of urineSpecific gravity of urine

Newborn 1006-10121-12 month – 1002-10062-5 years – 1009-1016

10-12 years – 1012-1025

Investigation of the child with urinary pathologyInvestigation 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 Patients complaints and methods of physical examinationexamination

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 conve nient 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:Causes of "kidney"pain:

1 - expansion of 1 - expansion of calyces and renal calyces and renal pelvis; pelvis;

2 - expansion of 2 - expansion of capsule; capsule;

3 - compression of 3 - compression of receptors; receptors;

4 - renal ischemia; 4 - renal ischemia; 5 - refluxes.5 - refluxes.

DysuriaDysuria

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 DiseaseSymptoms of Kidney Disease

Changes in UrinationKidneys 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 DiseaseSymptoms of Kidney Disease

SwellingFailing kidneys don't remove extra fluid, which

builds up in body causing swelling in the legs, ankles, feet, face, and/or hands.

FatigueHealthy 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 DiseaseSymptoms 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 DiseaseSymptoms of Kidney Disease

Nausea and VomitingLoss of appetite can lead to weight loss.Feeling ColdAnemia can make feel cold all the time, even

in a warm room.Dizziness and Trouble ConcentratingAnemia 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 DiseaseSymptoms 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?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 DiseasesAcute 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 DiseasesChronic Kidney DiseasesUnfortunately, 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 DiseasesChronic 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.

AgenesiaAgenesia

AplasiaAplasia

DuplicationDuplication

PolycystosisPolycystosis

DystopiaDystopia

HypoplasiaHypoplasia

DysplasiaDysplasia

Chronic Kidney DiseasesChronic Kidney Diseases

Blocked urine flow and reflux.Blocked urine flow and reflux. If If blockage develops between the blockage develops between the kidneys and the opening where urine kidneys and the opening where urine leaves the body, the urine can back leaves the body, the urine can back up and damage the kidney.up and damage the kidney.

Chronic Kidney DiseasesChronic Kidney Diseases

Hereditary diseases.Hereditary diseases. In polycystic In polycystic kidney disease (PKD), children kidney disease (PKD), children inherit defective genes that cause inherit defective genes that cause the kidneys to develop many cysts, the kidneys to develop many cysts, sacs of fluid that replace healthy sacs of fluid that replace healthy tissue and keep the kidneys from tissue and keep the kidneys from doing their job. In Alport syndrome, doing their job. In Alport syndrome, the defective gene that causes the defective gene that causes kidney disease may also cause kidney disease may also cause hearing or vision loss.hearing or vision loss.

Chronic Kidney DiseasesChronic Kidney Diseases

Glomerular diseases.Glomerular diseases. Some Some diseases attack the individual diseases attack the individual filtering units in the kidney. When filtering units in the kidney. When damaged, these filters—which are damaged, these filters—which are called glomeruli—leak blood and called glomeruli—leak blood and protein into the urine. If the damage protein into the urine. If the damage to the glomeruli is severe, kidney to the glomeruli is severe, kidney failure may develop.failure may develop.

Chronic Kidney DiseasesChronic Kidney Diseases

Systemic diseases.Systemic diseases. Diabetes and lupus can affect Diabetes and lupus can affect many parts of the body, including the kidneys in some many parts of the body, including the kidneys in some people. In lupus, the immune system becomes people. In lupus, the immune system becomes overactive and attacks the body’s own tissues. overactive and attacks the body’s own tissues. Diabetes leads to high levels of blood glucose that Diabetes leads to high levels of blood glucose that damage the glomeruli. Diabetes is the leading cause damage the glomeruli. Diabetes is the leading cause of kidney failure in adults. In children, however, of kidney failure in adults. In children, however, diabetes is low on the list of causes because it usually diabetes is low on the list of causes because it usually takes many years of high blood glucose for the kidney takes many years of high blood glucose for the kidney disease of diabetes to develop. However, an disease of diabetes to develop. However, an increasing number of children have type 2 diabetes, increasing number of children have type 2 diabetes, which is usually associated with adults. As a result, which is usually associated with adults. As a result, we may see more children with chronic kidney failure we may see more children with chronic kidney failure caused by diabetes in the future. caused by diabetes in the future.

From birth to age From birth to age 4 years4 years, birth , birth defects and hereditary diseases defects and hereditary diseases are by far the leading causes of are by far the leading causes of kidney failure. kidney failure.

Between ages Between ages 5 and 14 years5 and 14 years, , hereditary diseases continue to be hereditary diseases continue to be the most common causes, followed the most common causes, followed closely by glomerular diseases. closely by glomerular diseases.

In the In the 15- to 19-year-old15- to 19-year-old age group, age group, glomerular diseases are the leading glomerular diseases are the leading cause, and hereditary diseases cause, and hereditary diseases become rarer.become rarer.

Urinary tract infections Urinary tract infections (UTIs)(UTIs)

are a common, potentially serious, and (especially in young are a common, potentially serious, and (especially in young

children) often occult bacterial infection of childhood. During children) often occult bacterial infection of childhood. During

childhood, UTI occurs in approximately 3-5% of girls and 1% of 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, 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 whereas the age of the first diagnosed UTI in girls is highly

variable. After 2 years of age, UTI in females exceeds that in 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 males by a factor of 10:1 (1). Uncircumcised males less than one

year old are more likely to be affected than circumcised males 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, (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, without other source of infection, is 5% (4). After 6 years of age,

and before the onset of sexual activity, incidence of UTI falls and before the onset of sexual activity, incidence of UTI falls

dramatically in both sexes. dramatically in both sexes.

Urinary tract infections Urinary tract infections (UTIs)(UTIs)

Many factors may Many factors may predisposepredispose a child to UTI, including a child to UTI, including abnormalities of the urinary tract such as abnormalities of the urinary tract such as

vesicoureteral reflux (VUR),vesicoureteral reflux (VUR), renal anomalies with hydronephrosis or renal anomalies with hydronephrosis or

obstruction,obstruction, neurogenic bladder, neurogenic bladder, or nephrolithiasis; or nephrolithiasis; functional abnormalities such as constipation,functional abnormalities such as constipation, fecal incontinence, fecal incontinence, or incomplete bladder emptying; or incomplete bladder emptying; and environmental factors such as bubble baths, and environmental factors such as bubble baths,

poor perineal hygiene, pinworms, or sexual activity, poor perineal hygiene, pinworms, or sexual activity, including sexual abuse. including sexual abuse.

Labial adhesions in girls and phimosis in boys also Labial adhesions in girls and phimosis in boys also contribute to an increased risk of UTI. contribute to an increased risk of UTI.

MegaloureterMegaloureter The aetiology The aetiology

resembles that of resembles that of Hirsch-sprung's Hirsch-sprung's disease, which often is disease, which often is associated. It is associated. It is assumed that faulty assumed that faulty parasympathetic parasympathetic innervation leads to innervation leads to defective detrusor defective detrusor function, bladder function, bladder dilation and reflux. dilation and reflux. Anatomical obstruction Anatomical obstruction has to be excluded.has to be excluded.

MegaloureterMegaloureter

Newborn with Newborn with several peculiar several peculiar features features Low-set, Low-set, malformed ears and malformed ears and heavy skinfolds heavy skinfolds under the eyes are under the eyes are reminiscent of reminiscent of Potter's face. Potter's face. He He developed urinary developed urinary symptoms.symptoms.

MegaloureterMegaloureter

Retrograde pyelographyRetrograde pyelography

A dilated bladder, bilateral tortuous megaloureters and right-sided hydronephrosis were revealed.

NURSING THE CHILD WITH DISEASES OF NURSING THE CHILD WITH DISEASES OF URINARYURINARYSYSTEMSYSTEMAny 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 edemaControl 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, cleanseand powder opposing skin surfaces several times daily, separate skinsurfaces with soft cotton, support edematous organs, such as scrotum,cleanse edematous eyelids with warm saline wipes.

Prevent further edema formation: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 DiseaseGrowth 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 As the first step in filtration, blood is delivered into the delivered into the glomeruliglomeruli by by microscopicmicroscopic leaky blood vessels called leaky blood vessels called capillariescapillaries. Here, . Here, blood is filtered of waste products and fluid blood is filtered of waste products and fluid while while redred bloodblood cellscells, , proteinsproteins, and large , and large molecules are retained in the capillaries. In molecules are retained in the capillaries. In addition to wastes, some useful substances addition to wastes, some useful substances are also filtered out. The filtrate collects in are also filtered out. The filtrate collects in a sac called Bowman's capsule and drains a sac called Bowman's capsule and drains into the tubule.into the tubule.

The tubules are the next The tubules are the next step in the filtration step in the filtration

process.process. The tubules are lined with highly The tubules are lined with highly

functional cells which process functional cells which process the filtrate, reabsorbing water the filtrate, reabsorbing water and chemicals useful to the body and chemicals useful to the body while secreting some additional while secreting some additional waste products into the tubulewaste products into the tubule..

The kidneys also produce certain The kidneys also produce certain hormoneshormones : :

Activate form of Activate form of vitaminvitamin D D ( (calcitriolcalcitriol or 1,25 dihydroxy-vitamin D), which or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and regulates absorption of calcium and phosphorusphosphorus from foods, promoting from foods, promoting formation of strong bone. formation of strong bone.

ErythropoietinErythropoietin ( (EPOEPO), which ), which stimulates the stimulates the bonebone marrowmarrow to to produce red blood cells.produce red blood cells.

Renin, which regulates blood volume Renin, which regulates blood volume and and bloodblood pressurepressure..

What is the difference between kidney What is the difference between kidney failure and kidney disease?failure and kidney disease?

Kidney failureKidney failure Kidney failure occurs when the kidneys Kidney failure occurs when the kidneys

partly or completely lose their ability to partly or completely lose their ability to carry out normal functions. carry out normal functions.

This is dangerous because water, waste, and This is dangerous because water, waste, and toxic substances build up that normally are toxic substances build up that normally are removed from the body by the kidneys. removed from the body by the kidneys.

It also causes other problems such as It also causes other problems such as anemiaanemia,, high blood pressure, high blood pressure, acidosisacidosis (excessive acidity of body fluids), disorders (excessive acidity of body fluids), disorders of of cholesterolcholesterol and and fattyfatty acidsacids,, and bone and bone disease in the body by impairing hormone disease in the body by impairing hormone production by the kidneys.production by the kidneys.

Stages of Chronic Kidney Stages of Chronic Kidney DiseaseDisease

StageDescriptionGFRStageDescriptionGFR

mL/min/1.73m2mL/min/1.73m21Slight kidney 1Slight kidney damage with normal or increased damage with normal or increased filtrationMore than 902Mild decrease filtrationMore than 902Mild decrease in kidney function60-893Moderate in kidney function60-893Moderate decrease in kidney function30-decrease in kidney function30-594Severe decrease in kidney 594Severe decrease in kidney function15-295Kidney failure requiring function15-295Kidney failure requiring dialysis or transplantationLess than 15dialysis or transplantationLess than 15

Chronic Kidney Disease Chronic Kidney Disease CausesCauses

Although chronic kidney disease sometimes Although chronic kidney disease sometimes results from primary diseases of the kidneys results from primary diseases of the kidneys themselves, the major causes are diabetes themselves, the major causes are diabetes and high blood pressure.and high blood pressure.

Type 1 and type 2 diabetes mellitus cause a Type 1 and type 2 diabetes mellitus cause a condition called condition called diabeticdiabetic nephropathynephropathy,, which which is the leading cause of kidney disease in the is the leading cause of kidney disease in the United States. United States.

High blood pressure (High blood pressure (hypertensionhypertension),), if not if not controlled, can damage the kidneys over controlled, can damage the kidneys over time. time.

Glomerulonephritis is the Glomerulonephritis is the inflammation and damage of the inflammation and damage of the filtration system of the kidneys and filtration system of the kidneys and can cause kidney failure. can cause kidney failure. Postinfectious conditions and Postinfectious conditions and lupuslupus are among the many causes of are among the many causes of glomerulonephritis. glomerulonephritis.

Polycystic kidney diseasePolycystic kidney disease is an is an example of a hereditary cause of example of a hereditary cause of chronic kidney disease wherechronic kidney disease where ii nn both kidneys have multiple both kidneys have multiple cystscysts..

Use of analgesics such as Use of analgesics such as acetaminophenacetaminophen ( (TylenolTylenol)) and and ibuprofenibuprofen (Motrin, Advil) regularly over long durations of (Motrin, Advil) regularly over long durations of time can cause time can cause analgesicanalgesic nephropathynephropathy, another cause of , another cause of kidney disease. Certain other medications can also kidney disease. Certain other medications can also damage the kidneys. damage the kidneys.

Clogging and Clogging and hardeninghardening ofof thethe arteriesarteries ( (atherosclerosisatherosclerosis) ) leading to the kidneys causes a condition called ischemic leading to the kidneys causes a condition called ischemic nephropathy, which is another cause of progressive nephropathy, which is another cause of progressive kidney damage. kidney damage.

Obstruction of the flow of urine by stones, an Obstruction of the flow of urine by stones, an enlargedenlarged prostateprostate,, strictures (narrowings), or cancers may also strictures (narrowings), or cancers may also cause kidney disease. cause kidney disease.

Other causes of chronic kidney disease include Other causes of chronic kidney disease include HIV HIV infectioninfection, , sicklesickle cellcell diseasedisease, , heroinheroin abuseabuse, , amyloidosisamyloidosis,, kidney stones, chronic kidney infections, and certain kidney stones, chronic kidney infections, and certain cancers. cancers.

Chronic Kidney Disease Chronic Kidney Disease SymptomsSymptoms

FatigueFatigue and weakness (from anemia or and weakness (from anemia or accumulation of waste products in the body) accumulation of waste products in the body)

Loss of appetite, Loss of appetite, nauseanausea andand vomitingvomiting NeedNeed toto urinateurinate frequentlyfrequently, especially at night, especially at night Swelling of the legs and puffiness around the eyes Swelling of the legs and puffiness around the eyes

(fluid retention)(fluid retention) ItchingItching,, easy bruising, and pale skin (from anemia) easy bruising, and pale skin (from anemia) HeadachesHeadaches,, numbness in the feet or hands numbness in the feet or hands ((

peripheralperipheral neuropathyneuropathy),), disturbeddisturbed sleepsleep, altered , altered mental status (encephalopathy from the mental status (encephalopathy from the accumulation of waste products or uremic accumulation of waste products or uremic poisons), and poisons), and restlessrestless legslegs syndromesyndrome

High blood pressure, High blood pressure, chestchest painpain due due to to pericarditispericarditis (inflammation around (inflammation around the heart) the heart)

Shortness of breath from fluid in Shortness of breath from fluid in lungs lungs

Bleeding (poor blood clotting) Bleeding (poor blood clotting) Bone pain and fractures Bone pain and fractures Decreased sexual interest and Decreased sexual interest and erectileerectile

dysfunctiondysfunction

Some signs and symptoms represent the possibility of a Some signs and symptoms represent the possibility of a severe complication of chronic kidney disease and severe complication of chronic kidney disease and warrant a visit to the nearest hospital warrant a visit to the nearest hospital emergencyemergency

departmentdepartment..

Change in level of consciousness - Change in level of consciousness - extreme sleepiness or difficult to extreme sleepiness or difficult to awakenawaken

FaintingFainting Chest pain Chest pain Difficulty breathing Difficulty breathing Severe nausea and vomiting Severe nausea and vomiting Severe bleeding (from any source) Severe bleeding (from any source) Severe weaknessSevere weakness

Exams and TestsExams and Tests

UrinalysisUrinalysis:: Analysis of the urine affords Analysis of the urine affords enormous insight into the function of enormous insight into the function of the kidneys. The first step in urinalysis the kidneys. The first step in urinalysis is doing a dipstick test. The dipstick has is doing a dipstick test. The dipstick has reagents that check the urine for the reagents that check the urine for the presence of various normal and presence of various normal and abnormal constituents including abnormal constituents including protein. Then, the urine is examined protein. Then, the urine is examined under a microscope to look for red and under a microscope to look for red and white blood cells, and the presence of white blood cells, and the presence of casts and crystals (solids). casts and crystals (solids).

Only minimal quantities of Only minimal quantities of albuminalbumin (protein) are present in urine normally. (protein) are present in urine normally. A positive result on a dipstick test for A positive result on a dipstick test for protein is abnormal. More sensitive than protein is abnormal. More sensitive than a dipstick test for protein is a laboratory a dipstick test for protein is a laboratory estimation of the urine albumin estimation of the urine albumin (protein) and (protein) and creatininecreatinine in the urine. in the urine. The ratio of albumin (protein) and The ratio of albumin (protein) and creatinine in the urine provides a good creatinine in the urine provides a good estimate of albumin (protein) excretion estimate of albumin (protein) excretion per day. per day.

Twenty-four-hour urine tests:Twenty-four-hour urine tests:

This test requires you to collect all of This test requires you to collect all of your urine for 24 consecutive hours. your urine for 24 consecutive hours. The urine may be analyzed for protein The urine may be analyzed for protein and waste products (and waste products (ureaurea, nitrogen, , nitrogen, and creatinine). The presence of and creatinine). The presence of protein in the urine indicates kidney protein in the urine indicates kidney damage. The amount of creatinine and damage. The amount of creatinine and urea excreted in the urine can be used urea excreted in the urine can be used to calculate the level of kidney function to calculate the level of kidney function and the glomerular filtration rate and the glomerular filtration rate (GFR).(GFR).

Glomerular filtration rate (GFR):Glomerular filtration rate (GFR):

The GFR is a standard means of The GFR is a standard means of expressing overall kidney function. As expressing overall kidney function. As kidney disease progresses, GFR falls. kidney disease progresses, GFR falls. The normal GFR is about 100-140 The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in mL/min in men and 85-115 mL/min in women. It decreases in most people women. It decreases in most people with age. The GFR may be calculated with age. The GFR may be calculated from the amount of waste products in from the amount of waste products in the 24-hour urine or by using special the 24-hour urine or by using special markers administered intravenouslymarkers administered intravenously

Blood testsBlood tests

Creatinine and urea (BUN) in the Creatinine and urea (BUN) in the blood: blood: Blood urea nitrogen and serum Blood urea nitrogen and serum creatinine are the most commonly used creatinine are the most commonly used blood tests to screen for, and monitor blood tests to screen for, and monitor renal disease. Creatinine is a breakdown renal disease. Creatinine is a breakdown product of normal muscle breakdown. product of normal muscle breakdown. Urea is the waste product of breakdown Urea is the waste product of breakdown of protein. The level of these substances of protein. The level of these substances rises in the blood as kidney function rises in the blood as kidney function worsens.worsens.

Electrolyte levels and acid-Electrolyte levels and acid-base balance:base balance:

Kidney dysfunction causes Kidney dysfunction causes imbalances in electrolytes, especially imbalances in electrolytes, especially potassium, phosphorus, and calcium. potassium, phosphorus, and calcium. High potassium (hyperkalemia) is a High potassium (hyperkalemia) is a particular concern. The acid-base particular concern. The acid-base balance of the blood is usually balance of the blood is usually disrupted as well.disrupted as well.

Decreased production of the active Decreased production of the active form of vitamin D can cause low form of vitamin D can cause low levels of calcium in the blood. levels of calcium in the blood. Inability to excrete phosphorus by Inability to excrete phosphorus by failing kidneys causes its levels in failing kidneys causes its levels in the blood to rise. Testicular or the blood to rise. Testicular or ovarian hormone levels may also be ovarian hormone levels may also be abnormal.abnormal.

Blood cell counts:Blood cell counts:

Because kidney disease disrupts Because kidney disease disrupts blood cell production and shortens blood cell production and shortens the survival of red cells, the red blood the survival of red cells, the red blood cell count and hemoglobin may be cell count and hemoglobin may be low (anemia). Some patients may also low (anemia). Some patients may also have iron deficiency due to blood loss have iron deficiency due to blood loss in their gastrointestinal system. Other in their gastrointestinal system. Other nutritional deficiencies may also nutritional deficiencies may also impair the production of red cells.impair the production of red cells.

Ultrasound:Ultrasound: Ultrasound is often used in the diagnosis Ultrasound is often used in the diagnosis

of kidney disease. An ultrasound is a of kidney disease. An ultrasound is a noninvasive type of test. In general, noninvasive type of test. In general, kidneys are shrunken in size in chronic kidneys are shrunken in size in chronic kidney disease, although they may be kidney disease, although they may be normal or even large in size in cases normal or even large in size in cases caused by adult polycystic kidney disease, caused by adult polycystic kidney disease, diabetic nephropathy, and amyloidosis. diabetic nephropathy, and amyloidosis. Ultrasound may also be used to diagnose Ultrasound may also be used to diagnose the presence of urinary obstruction, the presence of urinary obstruction, kidney stones and also to assess the blood kidney stones and also to assess the blood flow into the kidneys.flow into the kidneys.

The rules of preparation of the patient for The rules of preparation of the patient for emergency urographv:emergency urographv:

On the eve in the evening to use a cleansing enema (not highOn the eve in the evening to use a cleansing enema (not high

siphon).siphon). If possible, to eliminate the reception of medicinal If possible, to eliminate the reception of medicinal

remediesremedies

On the eve to check the sensitivity of an organism to X-ray On the eve to check the sensitivity of an organism to X-ray contrastcontrastsubstance.substance.

On the day of urography a patient should have On the day of urography a patient should have mildmildnoncarbohydrate breakfast in the morning, 2-3 hours prior noncarbohydrate breakfast in the morning, 2-3 hours prior to theto thebeginning of urography, which that prevents derivation of beginning of urography, which that prevents derivation of gasesgasesdue to hungerness in the intestine.due to hungerness in the intestine.

Biopsy:Biopsy:

A sample of the kidney tissue (biopsy) is A sample of the kidney tissue (biopsy) is sometimes required in cases in which sometimes required in cases in which the cause of the kidney disease is the cause of the kidney disease is unclear. Usually, a biopsy can be unclear. Usually, a biopsy can be collected with local anesthesia only by collected with local anesthesia only by introducing a needle through the skin introducing a needle through the skin into the kidney. This is usually done as into the kidney. This is usually done as an outpatient procedure, though some an outpatient procedure, though some institutions may require an overnight institutions may require an overnight hospital stay. hospital stay.

Congenital problems of the Congenital problems of the urinary tract.urinary tract.

As a fetus develops in the womb, any part of the As a fetus develops in the womb, any part of the urinary tract can grow to an abnormal size or in an urinary tract can grow to an abnormal size or in an abnormal shape or position. One common congenital abnormal shape or position. One common congenital abnormality (an abnormality that exists at birth) is abnormality (an abnormality that exists at birth) is duplication of the ureters, in which a kidney has two duplication of the ureters, in which a kidney has two ureters coming from it instead of one. This defect ureters coming from it instead of one. This defect occurs in about 1 out of every 125 births and can occurs in about 1 out of every 125 births and can cause the kidney to develop problems with repeated cause the kidney to develop problems with repeated infections and scarring over time.infections and scarring over time.

Another congenital problem is horseshoe kidney, Another congenital problem is horseshoe kidney, where the two kidneys are fused (connected) into where the two kidneys are fused (connected) into one arched kidney that usually functions normally, one arched kidney that usually functions normally, but is more prone to develop problems later in life. but is more prone to develop problems later in life. This condition is found in 1 out of every 500 births.This condition is found in 1 out of every 500 births.

GlomerulonephritisGlomerulonephritis

is an inflammation of the glomeruli, is an inflammation of the glomeruli, the parts of the filtering units the parts of the filtering units (nephrons) of the kidney that contain (nephrons) of the kidney that contain a network of capillaries (tiny blood a network of capillaries (tiny blood vessels). vessels).

The most common form is post-The most common form is post-streptococcal glomerulonephritis, streptococcal glomerulonephritis, which usually occurs in young which usually occurs in young children following a case of strep children following a case of strep throat. Most kids with this type of throat. Most kids with this type of nephritis recover fully, but a few can nephritis recover fully, but a few can have permanent kidney damage that have permanent kidney damage that eventually requires dialysis or a eventually requires dialysis or a kidney transplant.kidney transplant.

High blood pressureHigh blood pressure (hypertension)(hypertension)

can result when the kidneys are can result when the kidneys are impaired by disease. The kidneys impaired by disease. The kidneys control blood pressure by regulating control blood pressure by regulating the amount of salt in the body and the amount of salt in the body and by producing the enzyme renin that, by producing the enzyme renin that, along with other substances, along with other substances, controls the constriction of muscle controls the constriction of muscle cells in the walls of the blood cells in the walls of the blood vessels.vessels.

Kidney (renal) failureKidney (renal) failure

can be acute (sudden) or chronic can be acute (sudden) or chronic (occurring over time and usually (occurring over time and usually long lasting or permanent). In either long lasting or permanent). In either form of kidney failure, the kidneys form of kidney failure, the kidneys slow down or stop filtering blood slow down or stop filtering blood effectively, causing waste products effectively, causing waste products and toxic substances to build up in and toxic substances to build up in the blood.the blood.

Acute kidney failureAcute kidney failure

bacterial infection, injury, shock, bacterial infection, injury, shock, heart failure, poisoning, or drug heart failure, poisoning, or drug overdose. overdose.

TreatmentTreatment

includes correcting the problem that includes correcting the problem that led to the failure and sometimes led to the failure and sometimes requires surgery or dialysis. requires surgery or dialysis.

DialysisDialysis

Dialysis involves using a machine or Dialysis involves using a machine or other artificial device to remove the other artificial device to remove the excess salts and water and other excess salts and water and other wastes from the body when the wastes from the body when the kidneys are unable to perform this kidneys are unable to perform this function.function.

Chronic kidney failureChronic kidney failure

involves a deterioration of kidney involves a deterioration of kidney function over time. In children, it can function over time. In children, it can result from acute kidney failure that result from acute kidney failure that fails to improve, birth defects of the fails to improve, birth defects of the kidney, chronic kidney diseases, kidney, chronic kidney diseases, repeated kidney infections, or chronic repeated kidney infections, or chronic severe high blood pressure. If severe high blood pressure. If diagnosed early, chronic kidney failure diagnosed early, chronic kidney failure in children can be treated but usually in children can be treated but usually not reversed. not reversed.

The child will usually require a The child will usually require a kidney transplant at some point in kidney transplant at some point in the future.the future.

Kidney stonesKidney stones

(or nephrolithiasis) result from the (or nephrolithiasis) result from the buildup of crystallized salts and buildup of crystallized salts and minerals such as calcium in the minerals such as calcium in the urinary tract. Stones (also called urinary tract. Stones (also called calculi) can also form after an calculi) can also form after an infection. infection.

If kidney stones are large enough to If kidney stones are large enough to block the kidney or ureter, they can block the kidney or ureter, they can cause severe abdominal pain. But cause severe abdominal pain. But the stones usually pass through the the stones usually pass through the urinary tract on their own. In some urinary tract on their own. In some cases, they may need to be removed cases, they may need to be removed surgically.surgically.

NephritisNephritis

NephritisNephritis is any inflammation of the is any inflammation of the kidney. It can be caused by infection, kidney. It can be caused by infection, medications, an autoimmune disease medications, an autoimmune disease (such as lupus), or it may be (such as lupus), or it may be idiopathic (which means the exact idiopathic (which means the exact cause may not be known or cause may not be known or understood). Nephritis is generally understood). Nephritis is generally detected by protein and blood in the detected by protein and blood in the urine.urine.

Nephrotic syndromeNephrotic syndrome

is a type of kidney disease that leads is a type of kidney disease that leads to loss of protein in the urine and to loss of protein in the urine and swelling of the face (often the eyes) swelling of the face (often the eyes) or body (often around the genitals). or body (often around the genitals). It is most common in children It is most common in children younger than 6 years old and is younger than 6 years old and is more prevalent in boys..  more prevalent in boys..  

Nephrotic syndrome is often treated Nephrotic syndrome is often treated with steroidswith steroids

Urinary tract infectionsUrinary tract infections (UTIs)(UTIs) are usually caused by intestinal are usually caused by intestinal

bacteria, such as bacteria, such as E. coliE. coli, normally found in , normally found in feces. These bacteria can cause infections feces. These bacteria can cause infections anywhere in the urinary tract, including anywhere in the urinary tract, including the kidneys. Most UTIs occur in the lower the kidneys. Most UTIs occur in the lower urinary tract, in the bladder and urethra. urinary tract, in the bladder and urethra. UTIs occur in both boys and girls. UTIs occur in both boys and girls. However, uncircumcised males are about However, uncircumcised males are about 3 to 12 times more likely than circumcised 3 to 12 times more likely than circumcised males to develop a UTI before age 1. males to develop a UTI before age 1. Although uncircumcised males are about Although uncircumcised males are about 3 to 12 times more likely than circumcised 3 to 12 times more likely than circumcised males to develop a UTI before age 1, males to develop a UTI before age 1,

In school-age children, girls are In school-age children, girls are more likely to develop UTIs than more likely to develop UTIs than boys; this may be because girls have boys; this may be because girls have shorter urethras than boys.shorter urethras than boys.

Vesicoureteral reflux (VUR)Vesicoureteral reflux (VUR)

is a condition in which urine abnormally is a condition in which urine abnormally flows backward (or refluxes) from the flows backward (or refluxes) from the bladder into the ureters. It may even reach bladder into the ureters. It may even reach the kidneys, where infection and scarring the kidneys, where infection and scarring can occur over time. VUR occurs in 1% of can occur over time. VUR occurs in 1% of children and tends to run in families. It's children and tends to run in families. It's often detected after a young child has a often detected after a young child has a first urinary tract infection. Most kids first urinary tract infection. Most kids outgrow mild forms of VUR, but some can outgrow mild forms of VUR, but some can develop permanent kidney damage and develop permanent kidney damage and kidney failure later in life.kidney failure later in life.

Wilms' tumorWilms' tumor

is the most common kidney cancer is the most common kidney cancer occurring in children. It is diagnosed occurring in children. It is diagnosed most commonly between 2 and 5 most commonly between 2 and 5 years of age and affects males and years of age and affects males and females equally.females equally.

How does the urinary system How does the urinary system work?work?

VVoidingoiding

Urination, or voiding, is a complex Urination, or voiding, is a complex activity. The bladder is a balloon-like activity. The bladder is a balloon-like organ that lies in the lowest part of organ that lies in the lowest part of the abdomen. The bladder stores the abdomen. The bladder stores urine, then releases it through the urine, then releases it through the urethra, the canal that carries urine urethra, the canal that carries urine to the outside of the body. Controlling to the outside of the body. Controlling this activity involves nerves, muscles, this activity involves nerves, muscles, the spinal cord, and the brain.the spinal cord, and the brain.

The bladderThe bladder

The bladder is composed of two types of The bladder is composed of two types of muscles: the detrusor, a muscular sac that muscles: the detrusor, a muscular sac that stores urine and squeezes to empty; and stores urine and squeezes to empty; and the sphincter, a circular group of muscles the sphincter, a circular group of muscles at the bottom or neck of the bladder that at the bottom or neck of the bladder that automatically stay contracted to hold the automatically stay contracted to hold the urine in and automatically relax when the urine in and automatically relax when the detrusor contracts to let the urine into the detrusor contracts to let the urine into the urethra. A third group of muscles below the urethra. A third group of muscles below the bladder (pelvic floor muscles) can contract bladder (pelvic floor muscles) can contract to keep urine back.to keep urine back.

Infrequent VoidingInfrequent Voiding

Infrequent voiding refers to a child’s voluntarily holding urine for Infrequent voiding refers to a child’s voluntarily holding urine for

prolonged intervalsprolonged intervals

small bladder capacitystructural problems

anxiety-causing eventspressure 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 Incontinence is also called enuresisenuresis

Primary enuresis is wetting in a person Primary enuresis is wetting in a person who has never been dry for at least 6 who has never been dry for at least 6 months.months.

Secondary enuresis is wetting that begins Secondary enuresis is wetting that begins after at least 6 months of dryness.after at least 6 months of dryness.

Nocturnal enuresis is wetting that usually Nocturnal enuresis is wetting that usually occurs during sleep, also called nighttime occurs during sleep, also called nighttime incontinence.incontinence.

Diurnal enuresis is wetting when awake, Diurnal enuresis is wetting when awake, also called daytime incontinence.also called daytime incontinence.

What is a UTI?What is a UTI?

A urinary tract infection (UTI) develops A urinary tract infection (UTI) develops when part of your urinary system becomes when part of your urinary system becomes infected, usually by bacteria. Bacteria can infected, usually by bacteria. Bacteria can enter your urinary system through the enter your urinary system through the urethra or, more rarely, through your urethra or, more rarely, through your bloodstream.bloodstream.

There are two different There are two different types of UTI:types of UTI:

Lower UTI:Lower UTI: this is an infection of the this is an infection of the lower part of the urinary tract, which lower part of the urinary tract, which includes the bladder and the urethra. includes the bladder and the urethra. An infection of the bladder is called An infection of the bladder is called cystitis and an infection of the urethra cystitis and an infection of the urethra is known as urethritis. is known as urethritis.

Upper UTI:Upper UTI: this is an infection of the this is an infection of the upper part of the urinary tract, upper part of the urinary tract, which includes the kidneys and the which includes the kidneys and the ureters. An infection of the kidneys is ureters. An infection of the kidneys is called pyelonephritis. called pyelonephritis.

Maintain the diet; the major attention Maintain the diet; the major attention should be taken to the patients in should be taken to the patients in the period of unsalted diet.the period of unsalted diet. At the At the indication of the doctor careful indication of the doctor careful examine of the intake andexamine of the intake andexcreted fluid. excreted fluid.

First aidFirst aidat ischuriaat ischuria

Put a warm water bag on the over the lower part of the abdomen.Put a warm water bag on the over the lower part of the abdomen. At the absence of contraindication (high temperature, cardiovascularAt the absence of contraindication (high temperature, cardiovascular pathology, etc.) it is possible to put the child into a warm bath.pathology, etc.) it is possible to put the child into a warm bath. For some children the reflex on urination can be developed at theFor some children the reflex on urination can be developed at the

sound of water current from the tap.sound of water current from the tap. Sometimes it is enough to leave the patient alone, and he will urinateSometimes it is enough to leave the patient alone, and he will urinate The patient may not be able to urinate in horizontal position - it isThe patient may not be able to urinate in horizontal position - it is

necessary to make such a child sit and the urinary bladder will benecessary to make such a child sit and the urinary bladder will beemptied.emptied.

Sometimes, it is effective for urination to drain some warm water onSometimes, 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 the external sexual oraans of girls or put the penis of bovs into warm

water.water. Inform the doctor who will do catheterization of the urinary badder, Inform the doctor who will do catheterization of the urinary badder,

ififnecessary.necessary.

Remindable point: watch if the child urinated or not, how many Remindable point: watch if the child urinated or not, how many times a day and what quantity of urine he/she excreted.times a day and what quantity of urine he/she excreted.

At renal colicAt renal colic

accompanying by very strong, accompanying by very strong, intolerant pains in the lumbar intolerant pains in the lumbar region:region:

A hot water bag on pain area.A hot water bag on pain area. The hot bath (at the absence of The hot bath (at the absence of

contraindications) - the temperature contraindications) - the temperature of water should be more than 0 Cof water should be more than 0 C

Call the doctor.Call the doctor.