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Acute kidney injury (AKI) in children is a critical medical condition characterized by a sudden decline in kidney function. This article provides a comprehensive overview of AKI in pediatric populations, exploring its pathophysiology, the role of various drugs and the long-term implications for kidney health. Key topics include oliguria, anuria, urine output, hypervolemia and the interactions among them, as well as role of diuretic nephrotoxicity and the glomerular filtration rate. Concepts of electrolytes, acid–base balance and renal perfusion assessment are presented. Basic principles of intensive care unit (ICU) management, renal replacement therapy and the association with multiorgan failure are described. Additionally, the article discusses the potential long-term outcomes of AKI, including the risk of chronic kidney disease, hypertension and proteinuria.

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.

Lower urinary tract dysfunction, closely related to bowel dysfunction, means functional abnormalities of the bladder and urethra. Different types of lower urinary tract dysfunction are divided according to symptoms or according to the cause. Treatment is directed to the cause. Neurogenic lower urinary tract dysfunction can cause irreversible damage to the upper urinary tract and changes in the bladder wall long before the clinical picture manifests as urinary leakage. Therefore, it is essential to diagnose the neurogenic defect with the resulting lower urinary tract dysfunction as soon as possible after birth and to treat the condition proactively. The standard therapy for neurogenic lower urinary tract dysfunction is clean intermittent catheterization in combination with an anticholinergic. Non-neurogenic lower urinary tract dysfunction, resulting in sudden, unexpected urge to void, urgency, leakage of urine, sphincter-detrusor dyssynergy and other forms, is often associated with a deterioration in the quality of life and negatively affects the child‘s self-esteem. The child develops different behavioural patterns to delay urination or stop the urgency. With anamnestic data, a diary and a clinical picture, we can easily define the diagnosis and start as soon as possible with non-pharmacological measures, standard and various types of special urotherapy.

Lower urinary tract dysfunction is clinically relevant because it may cause urinary tract infections, mainly due to accumulation of residual urine, adversely affect renal function, and may cause urine incontinence that strongly affects the child’s quality of life. The function of the lower urinary tract is closely associated with that of the bowel, as constipation is commonly associated with bladder dysfunction. Detrusor overactivity, a benign but socially harmful condition, is the leading cause of daytime urinary incontinence in child-hood and needs to be differentiated from more severe conditions such as neurogenic bladder dysfunction or urethral obstruction. Voiding dysfunction, a habitual sphincter con-traction 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, the neurogenic bladder dysfunction, most often caused by spinal dysraphism, which is characterized by several subtypes of lower urinary tract dysfunction. This condition very often leads to recurrent urinary tract infections and high intravesical pressures, threatening kidney function. A voiding diary is crucial in the initial evaluation of lower uri-nary tract function in children.

Congenital anomalies of the kidney and urinary tract represent a wide range of malformations that result from inadequate embryonic development and can often present as part of a syndrome. Although the aetiology of anomalies appears to be multifactoral in the majority of cases, a small proportion can be associated with monogenic or chromosomic variation, such as mutations in a specific gene or chromosome. A higher diagnostic yield of genetic testing is associated with severe anomalies affecting both renal parenchymas, a family history of kidney disease, and the presence of extrarenal features. Next-generation sequencing is increasingly being recognized as an important method in diagnosing congenital anomalies of the kidney and urinary tract. When there are concomitant multiple congenital malformations, development delay and/or dysmorphic features, microarray based genetic testing is advised.

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.

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.

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.

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.

Necrotizing stomatitis is a rare, acute-onset disease that is usually associated with severely malnourished children or diminished systemic resistance. We describe a 1-year-old girl who developed necrotizing stomatitis, vasculitic rash, skin desquamation on the fingers and toes, and persistent hypertension after serologically confirmed SARS-CoV-2 infection. Her laboratory investigations revealed positive IgG anticardiolipin and IgG anti-β2 glycoprotein antibodies, and biopsy of the mucosa of the lower jaw showed necrosis and endothelial damage with mural thrombi. Swollen endothelial cells of small veins in the upper dermis were confirmed also by electron microscopy. As illustrated by our case, necrotizing stomatitis may develop as a rare complication associated with SARS-CoV-2 infection and can be considered as a part of the clinical spectrum of COVID-19 vasculopathy. The pathogenic mechanism could involve a consequence of inflammatory events with vasculopathy, hypercoagulability, and damage of endothelial cells as a response to SARS-CoV-2 infection.

Congenital anomalies of the kidney and urinary tract are the commonest congenital anomalies in children, often detected prenatally with ultrasound. This method is useful for assesing the degree of dilatation of the collecting system, structure of the kidney parenchyma, amount of amniotic fluid and urinary bladder. Hydronephrosis is the most common among them. Anomalies can be bilateral or unilateral and different defects may coexist in an individual child. Anomalies of other organs and organ systems are often associated with anomalies of the kidneys and urinary tract, described in numerous syndromes. Congenital anomalies of the kidney and urinary tract can be divided in anomalies of the renal parencyma development, renal embryonic migration and position, cystic kidney diseases and anomalies of the urinary tract (collecting system of the kidneys, ureters, urinary bladder and urethra). They are the commonest cause of end-stage renal disease in children.