1: Urology - UTIs Flashcards
What is an upper urinary tract infection
pyelonephritis
What is a lower urinary tract infection
cystitis
What is the difference between lower urinary tract infection and urethritis
lower urinary tract infections occur above the bladder neck (cystitis) whereas, urethritis is below
in which gender are UTIs more common before 3m
boys
in which gender are UTIs more common after 3m
girls (3:1)
what is the most common cause of UTIs in children
E.coli
if paediatric UTIs are caused by anything but E.coli what is it classed as
Atypical
What are three hypothesised causes of UTIs
- Incomplete bladder emptying
- Poor hygiene
- Vesico-ureteric reflux
Give 4 causes of incomplete bladder emptying
- Hurried micturition
- Constipation
- Infrequent voiding due to vulvitis
- Neuropathic bladder
What proportion of children with UTIs have vesico-ureteric reflux
35%
What are poor hygiene causes of UTIs
Girls - wiping back to front
When should UTI be suspected in infants
Fever of unknown origin or sepsis
What are three features of UTI in neonates
- Prolonged neonatal jaundice
- Vomiting
- Sepsis
What are 6 features of UTIs in infants
- Irritable
- Poor Feeding
- Fever
- Febrile Convulsions
- Diarrhoea
- FTT
What are 6 features of UTI in children 1-5y
- Fever
- Rigors
- Malaise
- Abdominal pain
- Dysuria
- Urinary frequency
- Enuresis
How will children over 5 with cystitis present
Dysuria
Frequency
Enuresis
How will children over 5 with acute pyelonephritis present
Abdominal pain
Fever
If a child has a T of >38 what does it likely indicate
Upper UTI (pyelonephritis)
What are three indicators to check urine in a child
- Symptoms UTI
- T > 38
- Fever of unknown-origin
What is the best method to collect urine from a child recommended by NICE
Clean catch urine sample
What is clean catch sample
Parent holds a pot to catch childs urine
What is second-line method for collecting urine
Urine collection pads
When are absorbent pads more useful
Children who wear nappies
When may invasive (supra-pubic aspiration be used)
- Only if non-invasive methods are ineffective
- Child is very unwell and requires immediate diagnosis
What is adhesive plastic bag as urine collection method
A plastic-bag is attached to child’s perineum
What is the problem with adhesive plastic bags
often lead to contamination
When is mid-stream urine sample indicated
in continent child
Explain investigation for infants under 3-months with UTI
- All children should be referred to specialist paediatrician
- Send urine for MC+S
- Renal USS (All children under 6-months with first UTI)
When should children 3m-3y be admitted with UTI
If acute pyelonephritis suspected
What is used to investigate a UTI in 3m-3y
Urinalysis
In a child 3m-3y if leucocytes or nitrites, or both, are positive what should be done
If both, or one is positive - send urine for MC+S and start antibiotics
In a child 3m-3y if leucocytes and nitrites are negative, what should be done
Not a UTI
What is first line to investigate a UTI in children over 3y
Urinalysis
In a child >3y, what should be done if leucocytes and nitrites are positive
Start antibiotics. Do not need to send culture unless high-risk or very unwell
In a child >3y if nitrites are positive and leucocytes negative what should be done
Send urine for MC+S
Start antibiotics
In a child >3y if leucocytes are positive and nitrites negative what should be done
Send urine for MC+S
Do not start antibiotics
In a child >3y if leucocytes and nitrites are negative what does this mean
If is not a UTI
What is first-line imaging for UTIs in children
Renal US
What are the four indications for urinary US in UTI
- Atypical Infection
- First UTI under 6m
- Recurrent UTI under 6m
- Recurrent UTI over 6m
What are 6 indicatiors of atypical infection in children
- Poor urine flow
- Bladder or abdominal mass
- Any organism but E.coli
- Raised creatinine
- Sepsis
- Failure to respond to antibiotics in 48h
If child under 6 months and first UTI how quickly should US renal tract be ordered
Within 6W
If child under 6 months and recurrent UTI how quickly should US renal tract be ordered
During Acute infection
If child over 6 months and recurrent UTI how quickly should US renal tract be ordered
Within 6W
What does a DMSA scan look for
Damage to renal parenchyma
What are the two indications for DMSA scan for UTI
- Children under 6m with atypical or recurrent UTI
2. Children over 6m with recurrent UTI
When should a DMSA scan be performed following a UTI
4-6W
If a child <6m is suspected to have vesico-ureteric reflux what is used to investigate
MCUG = micturating cystourethrogram
If a child is >6m and is suspected to have vesico-ureteric reflux what is used
MAG3 = techniteum-99 scan
If a infant <3m is suspected to have acute pyelonephritis how should they be managed
- Refer to paediatric specialist
- IV 3rd gen cephalosporins
In a child 3m-15y with acute pyelonephritis how should they be managed
- Admit
- Oral cefalexin or co-amoxiclav
What is used for analgesia in acute pyelonephritis in children
Paracetamol
What is used for analgesia in acute pyelonephritis for children >12
Codiene
How should infants under 3-months with suspected cystitis be managed
- Refer to paediatric specialist
- Admit for IV 3rd gen cephalosporin
How should child 3-15 years be managed if suspected cystitis
- Oral trimethoprim
2. If resistance to trimethoprim is high in the area and eGFR >45, give oral nitrofurantoin
What is a complication of UTI in children
Can lead to renal scarring - if bilateral may result in chronic HTN
Define a recurrent UTI
- More than two upper-UTIs (pyelonephritis)
- One upper-UTI (pyelonephritis) and lower-UTI (cystitis)
- Three or more lower UTIs (cystitis)
What are the indications for renal US in recurrent UTIs
- Child under 6m with recurrent UTIs = arrange during infection
- Child over 6m with recurrent UTIs = arrange up to 6m after
Aside from renal US, what type of imaging should be used in children with recurrent UTIs
DMSA within 4-6m
If a child under 3m has recurrent UTIs how should they be managed
Refer to paediatrics for parental antibiotics, send urine MC+S
How should a child over 3m with recurrent UTI be manage
Prophylactic antibiotics
