NCLEX 요약정리 (+NGN 포함) - 아동간호 Urinary & Renal

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1. Hemolytic uremic syndrome (HUS)

용혈성 요독 증후군은 Escherichia coli 설사의 생명을 위협하는 합병증으로, 적혈구 용혈, 혈소판 감소, 급성 신장 손상을 초래합니다. 치료는 탈수 예방이 목표이며, 과도한 당분이나 전해질 함량이 낮은 과일 주스는 권장되지 않습니다. 대신 일반 식단을 유지하면 설사 기간과 중증도가 단축됩니다.
2. Pyelonephritis

신우신염은 요로감염의 일종으로, 상부 요로/신장을 침범합니다. 증상으로는 배뇨통, 발열, 측복부 통증, 오심/구토 등이 있으며, 패혈증 및 급성 신장 손상 등의 합병증이 발생할 수 있습니다. 치료는 적절한 항생제 투여와 감염 악화 징후 모니터링이 중요합니다.
3. Nephrotic syndrome

신증후군은 자가면역질환으로, 2-7세 아동에게 주로 발생합니다. 특징은 단백뇨, 부종, 저알부민혈증으로, 면역글로불린 감소로 인한 감염 위험이 높습니다. 치료는 스테로이드와 면역억제제 사용, 식욕 관리, 감염 예방 등입니다. 재발 위험이 높아 지속적인 모니터링이 필요합니다.
4. Acute postinfectious glomerulonephritis

급성 후감염성 사구체신염은 특정 세균 감염 후 면역 복합체가 사구체에 침착되어 발생합니다. 증상으로는 고혈압, 부종, 혈뇨 등이 나타나며, 고혈압성 뇌병증, 폐부종 등의 합병증이 발생할 수 있습니다. 치료는 수분 및 나트륨 제한, 이뇨제 사용 등 보존적 관리가 중요합니다.

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1. Hemolytic uremic syndrome (HUS)

Hemolytic uremic syndrome (HUS) is a serious and potentially life-threatening condition that primarily affects the kidneys. It is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. HUS is most commonly triggered by an infection with Shiga toxin-producing Escherichia coli (STEC), particularly the O157:H7 strain, but can also be associated with other infections, certain medications, or underlying genetic or metabolic disorders. The pathogenesis of HUS involves the binding of Shiga toxin to endothelial cells, leading to endothelial injury, platelet activation, and the formation of microthrombi in the small blood vessels of the kidneys. This results in the destruction of red blood cells (hemolytic anemia), a decrease in platelet count (thrombocytopenia), and acute kidney injury. The severity of the condition can range from mild to life-threatening, with the potential for long-term complications such as chronic kidney disease, neurological impairment, and even death. Early recognition and prompt treatment are crucial in managing HUS. Supportive care, including fluid management, dialysis if necessary, and the use of antibiotics or other targeted therapies, can significantly improve outcomes. In severe cases, plasmapheresis or eculizumab, a monoclonal antibody that inhibits the complement system, may be considered. Prevention strategies focus on improving food safety, promoting good hygiene practices, and raising awareness about the condition among healthcare providers and the general public.
2. Pyelonephritis

Pyelonephritis is a serious bacterial infection that affects the kidneys and the upper urinary tract. It is typically caused by the spread of bacteria, most commonly Escherichia coli, from the lower urinary tract to the kidneys. Pyelonephritis can be classified as acute or chronic, with the acute form being more severe and requiring prompt medical attention. The main symptoms of pyelonephritis include fever, chills, flank or back pain, nausea, vomiting, and sometimes, lower urinary tract symptoms such as dysuria, frequency, and urgency. In severe cases, the infection can lead to sepsis, a life-threatening condition characterized by a systemic inflammatory response and organ dysfunction. The diagnosis of pyelonephritis typically involves a combination of clinical symptoms, laboratory tests (such as urine culture and urinalysis), and imaging studies (e.g., ultrasound, CT scan) to assess the extent of the infection and rule out other potential causes. Treatment for pyelonephritis usually involves the administration of antibiotics, which are selected based on the suspected causative organism and the patient's individual characteristics. In some cases, hospitalization may be necessary, particularly for patients with severe symptoms, underlying medical conditions, or signs of sepsis. Supportive care, such as fluid resuscitation and pain management, is also an important aspect of treatment. Prevention of pyelonephritis focuses on maintaining good urinary tract health, including proper hydration, regular urination, and prompt treatment of any underlying urinary tract infections. In some cases, prophylactic antibiotics may be prescribed for individuals at high risk of recurrent pyelonephritis.
3. Nephrotic syndrome

Nephrotic syndrome is a clinical condition characterized by the presence of heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It is a result of damage to the glomerular filtration barrier in the kidneys, leading to the excessive leakage of proteins from the bloodstream into the urine. The most common causes of nephrotic syndrome include primary glomerular diseases, such as minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy, as well as secondary causes, such as diabetes, systemic lupus erythematosus, and certain infections or medications. The hallmark symptoms of nephrotic syndrome include edema, often starting in the lower extremities and progressing to the face and abdomen, as well as foamy or frothy urine due to the high protein content. Patients may also experience fatigue, loss of appetite, and an increased risk of infections due to the impaired immune function associated with the condition. Diagnosis of nephrotic syndrome typically involves a combination of