Upgrade to remove ads
Renal agenesis, pediatric
Terms in this set (18)
Congenital absence of one (unilateral renal agenesis [URA]) or both (bilateral renal agenesis [BRA]) renal parenchymal tissue at birth
Lack of amniotic fluid (oligohydramnios) with BRA, causing complications such as impaired fetal lung development, thoracic compression, limb contractures, and other abnormalities
BRA is always fatal
Formerly called Potter's syndrome
The ureteric bud fails to develop.
Urine production decreases, leading to oligohydramnios.
Subsequent organ hypalgesia occurs.
Exact cause unknown
Genetics, possibly autosomal dominant
Teratogenic and environmental agents, such as retinoic acid and cocaine exposure
Parent with kidney malformation, especially absence of one kidney
Uncontrolled diabetes during pregnancy (renal agenesis in fetus)
Maternal body mass index greater than 30 (BRA)
Binge drinking (BRA)
Link to chromosomal abnormalities (trisomy 21, 22, 45-x mosaic)
Renal agenesis occurs in about 1 in2,900 births in the United States.
BRA is more common in males than females, occurring in about 1 in 5,000 births.
URA is more common in cases ofmultiple gestations and intrauterine growth restriction.
Urinary tract infections
Fetuses with BRA: oligohydramnios plus nonvisualization (with maternal sonogram) of fetal kidneys, ureters, and bladder
Neonates with BRA: Dry, loose skin; low-set, floppy ears; a broad, flat nose; recessed chin; prominent epicanthal folds (Potter facies); underdeveloped lungs
Absence of urine output during first 48 hours of life
Congenital cardiac defects
Diagnostic Test Results-Laboratory
Serum electrolyte levels may reveal hyponatremia, hypernatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia.
Arterial blood gases reveal metabolic acidosis.
Urinalysis may reveal microhematuria or proteinuria.
Complete blood count may reveal anemia due to deficiency of erythropoietin.
Diagnostic Test Results-Imaging
Maternal sonography reveals oligohydramnios along with nonvisualization of fetal kidneys, ureters, and bladder, confirming BRA.
Doppler studies may distinguish BRA from severe intrauterine growth restriction.
Abdominal ultrasound of neonate helps confirm renal abnormalities noted prenatally.
Chest X-ray of neonate reveals spontaneous pneumothorax and pulmonary hypoplasia.
Supportive care to parents of fetus with BRA
Comfort measures for infant with BRA
Nursing Considerations-Nursing Diagnoses
Impaired gas exchange
Ineffective airway clearance
Interrupted family processes
Nursing Considerations-Expected Outcomes
seek support systems and exhibit adequate coping behaviors
maintain optimal gas exchange, with adequate ventilation and oxygenation
maintain a patent airway
express understanding of the disorder and use support systems to assist with coping.
Nursing Considerations-Nursing Interventions
Allow the parents to verbalize their concerns and feelings related to the prognosis; provide physical and emotional support.
Encourage the parents to interact with their neonate and participate in care measures.
Explain all procedures and treatments related to care of the neonate.
Provide appropriate respiratory care measures.
Offer assistance of pastoral care or of a religious support person to assist with grieving.
Coping and family interaction
Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment, pediatric
Health history interview and physical assessment
Nutritional screening, pediatric
Oral drug administration, infant
Oral drug administration, older child
Oral drug administration, toddler
24-hour timed urine collection, pediatric
24-hour timed urine collection using a pediatric urine collection bag, pediatric female
24-hour timed urine collection using a pediatric urine collection bag, pediatric male
disorder, diagnosis, and treatment, including the fact that the condition is usually fatal in the first few days of the neonate's life
use of supportive care measures
possible development of hypertension, kidney stones, and urinary tract infections and measures to prevent them
importance of follow-up monitoring of kidney function and blood pressure.
Patient Teaching-Discharge Planning
Refer the family to support services, as needed.
YOU MIGHT ALSO LIKE...
Toxic shock syndrome
Vesicoureteral reflux, pediatric
Wilms tumor, pediatric
OTHER SETS BY THIS CREATOR