Lower urinary tract dysfunction is clinically important because it may cause urinary tract infections, mainly due to accumulation of residual urine, and adversely affect renal function. In addition, ...it may cause urinary incontinence, strongly affecting the child's quality of life. The function of the lower urinary tract is closely associated with function of the bowel because constipation is commonly present with bladder dysfunction. The interplay between the lower urinary tract and bowel function, coupled with common conditions such as detrusor overactivity and voiding dysfunction, requires a nuanced diagnostic approach. Detrusor overactivity, a benign but socially harmful condition, is the principal cause of daytime urinary incontinence in childhood. It needs to be differentiated from more serious conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter contraction during voiding, is common in children with detrusor overactivity and may be self limiting but may also result in residual urine and urinary tract infections. It may resemble, in severe cases, neurogenic bladder dysfunction, most often caused by spinal dysraphism, which very often leads to recurrent urinary tract infections and high intravesical pressures, jeopardizing renal function. A voiding diary is crucial in the initial evaluation of lower urinary tract function in children.
Abstract
Hypervolemia is a condition with an excess of total body water and when sodium (Na) intake exceeds output. It can have different causes, such as hypervolemic hyponatremia (often associated ...with decreased, effective circulating blood volume), hypervolemia associated with metabolic alkalosis, and end-stage renal disease. The degree of hypervolemia in critically ill children is a risk factor for mortality, regardless of disease severity. A child (under 18 years of age) with hypervolemia requires fluid removal and fluid restriction. Diuretics are able to increase or maintain urine output and thus improve fluid and nutrition management, but their benefit in preventing or treating acute kidney injury is questionable.
Abstract
Alkalosis is a disorder of acid–base balance defined by elevated pH of the arterial blood. Metabolic alkalosis is characterized by primary elevation of the serum bicarbonate. Due to several ...mechanisms, it is often associated with hypochloremia and hypokalemia and can only persist in the presence of factors causing and maintaining alkalosis. Respiratory alkalosis is a consequence of dysfunction of respiratory system's control center. There are no pathognomonic symptoms. History is important in the evaluation of alkalosis and usually reveals the cause. It is important to evaluate volemia during physical examination. Treatment must be causal and prognosis depends on a cause.
Disfunkcija spodnjih sečil je klinično pomembna, ker lahko povzroča okužbe sečil zaradi zastajanja urina v sečnem mehurju, negativno vpliva na delovanje ledvic in povzroča uhajanje urina s posledično ...pomembnim zmanjšanjem kakovosti otrokovega življena. Delovanje spodnjih sečil je tesno povezano z delovanjem črevesa, saj zaprtje pogosto sovpada z motnjami v delovanju spodnjih sečil. Čezmerna aktivnost detruzorja, benigna, a socialno škodljiva motnja, je glavni vzrok dnevnega uhajanja urina pri otrocih in jo moramo razlikovati od motenj, ki bolj ogrožajo zgornja sečila, kot je nevro-gena disfunkcija mehurja ali zapora sečnice. Disfunkcionalno uriniranje je posledica habitualnega krčenja mišic medeničnega dna med uriniranjem in je pogosto pri otrocih z nenevrogeno čezmerno aktivnostjo detruzorja. Vodi lahko v zastajanje urina po mikciji in okužbe sečil, v hujših primerih pa pomeni tveganje okvare zgornjih sečil, podobno kot nevrogena disfunkcija spodnjih sečil. Slednja je najpogosteje posledica spinalnega disrafizma in se klinično kaže z več podtipi glede na aktivnost sfinktra in detruzorja. Zelo pogosto povzroča ponavljajoče se okužbe sečil in zvišan tlak v mehurju, kar ogroža delovanje ledvic. Pri začetni obravnavi disfunkcije spodnjih sečil pri otrocih je bistven pripomoček dnevnik uriniranja.
Disfunkcija spodnjih sečil, ki je tesno povezana z disfunkcijo črevesa, pomeni nepravilnosti v delovanju sečnega mehurja in sečnice. Različne vrste disfunkcije spodnjih sečil delimo glede na simptome ...in glede na vzrok, v katerega je usmerjeno zdravljenje. Nevrogena disfunkcija spodnjih sečil lahko povzroči nepopravljivo okvaro zgornjih sečil in spremembe stene mehurja dolgo pred tem, ko se klinično izrazi kot uhajanje urina. Zato je pomembno, da čimprej po rojstvu ugotovimo, za kakšno nevrogeno okvaro s posledično disfunkcijo spodnjih sečil gre, in stanje zdravimo proaktivno. Standardno zdravljenje nevrogene disfunkcije spodnjih sečil je čista intermitentna kateterizacija mehurja v kombinaciji z antiholinergikom. Nenevrogena disfunkcija spodnjih sečil z nenadnim tiščanjem na vodo, uhajanjem urina, sfinkter-detruzor dissinergijo in drugimi oblikami, je pogosto povezana s poslabšanjem kakovosti življenja in neugodno vpliva na otrokovo samopodobo. Otrok razvije različne vedenjske vzorce za odložitev uriniranja ali prekinitev nenadnega tiščanja na vodo. Z anamnestičnimi podatki ter z dnevnikom in klinično sliko diagnozo enostavno opredelimo in čim prej pričnemo z nefarmakološkimi ukrepi, standardnimi ukrepi in z različnimi vrstami specialne uroterapije.
Background: To assess multicystic dysplastic kidneys (MCDK) in children, their complications and associated congenital genitourinary anomalies. Methods: Children with unilateral MCDK, evaluated ...between 2012 and 2020, were analyzed. In this retrospective study, data were obtained from electronic and paper health care records. Results: There were 80 children included. Follow-up time was 8.0 +/− 5.2 years (mean +/− standard deviation). None of them had hypertension. In total, 43.8% of the children had associated congenital genitourinary anomalies, most commonly cryptorchidism and vesicoureteral reflux (VUR), and 6.3% of these children had chromosomopathy. All of them had normal kidney function except one child with dysplasia of the contralateral kidney. Urinalysis was normal in 90% of children. Extrarenal malformations occurred in 22.5% of them. We observed spontaneous involution of MCDK in 38.8% of children in the observed period. Nephrectomy was performed in 12.5% of children, at an average age of 2.0 years. Conclusions: Children with a unilateral MCDK have a very good prognosis if the contralateral kidney is normal. Associated congenital genitourinary anomalies are common. Cryptorchidism was found to be the most common associated anomaly among boys, which is unique for this study. Most of these children do not suffer from hypertension, kidney dysfunction or other complications.
Prirojene nepravilnosti sečil vključujejo širok spekter malformacij, ki so posledica neustreznega embrionalnega razvoja sečil in se pogosto se pojavljajo v sklopu sindromov. Čeprav je etiologija ...prirojenih napak sečil v večini primerov verjetno multifaktorska, je v redkih primerih razvoj nepra-vilnosti sečil povezan z monogenskimi ali kromosomskimi vzroki, in sicer s patogenimi različicami v posameznem genu ali kromosomu. Verjetnost genetske etiologije je večja pri kompleksnih kliničnih slikah, kot je obojestranska parenhimska prizadetost ledvic, in ob pozitivni družinski anamnezi prirojenih nepravilnosti sečil in/ali sindromskega stanja. Pri diagnosticiranju prirojenih nepravilnosti sečil vse pogosteje uporabljamo genetske preiskave, ki temeljijo na metodi sekvenciranja naslednje generacije, pri pridruženih razvojnih nepravilnostih več organskih sistemov ter razvojnem zaostanku in/ali dizmorfnih znakih pa tudi molekularno kariotipizacijo.
Congenital anomalies of the kidneys and urinary tract are the commonest congenital anomalies in children, oen detected prenatally with ultrasound. This method is useful for assesing the degree of ...dilatation of the collecting system, the structure of the kidney parenchyma, amount of amniotic uid and the urinary bladder. Hydro-nephrosis is the most common among them. Anomalies can be either bilateral or unilateral, and dierent defects may coexist in an individual child. Anomalies of other organs and organ systems are oen associated with the anomalies of the kidneys and urinary tract described in numerous syndromes. Congenital anomalies of the kidneys and urinary tract can be divided in anomalies of the renal parenchyma development, renal embryonic migration and position, cystic kidney diseases and anomalies of the uri-nary tract (collecting system of the kidneys, ureters, urinary bladder and urethra). They are the commonest cause of end-stage renal disease in children.
Abstract
To perform proper and optimal catheterization, a urinary catheter of appropriate size has to be selected as the success of a procedure is often dependent on it. Catheterization of the ...urinary bladder is a common procedure in pediatric practice which is used for numerous diagnostic and therapeutic purposes. There are very few recommendations on how to choose the optimal size of a catheter on the basis of a child’s age or weight. Based on a few published relationships between a child’s age, body weight and urinary catheter size, as well as personal experience, the author has developed a formula for estimating urinary catheter size according to a child’s weight that reads as follows:
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. Presented formula may prove useful in everyday clinical practice and especially in emergency settings.
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