26. Renal disease in children

Question 1

UTI demographics:

Answer 1

• 3:1 girls:boys

Question 2

Lower UTI presentation:

Answer 2

-Dysuria, frequency, fever, abdo pain, vomiting

Question 3

Pyelonephritis presentation:

Answer 3

-Unwell, fever, rigors, loin pain, dysuria

Question 4

Urosepsis presentation:

Answer 4

-Cardiovascular instability, shock

Question 5

Diagnosis of UTI:

Answer 5

• Urine dip stick test: leukocytes and nitrites

- Urine microscopy and culture (clean catch, suprapubic aspiration, catheter urine)

Question 6

Risk factors for UTI:

Answer 6

• Female
• Constipation
• Neuropathic bladder
• Structural abnormalities of the urinary tract (posterior urethral valves, vesico-ureteric reflux)

Question 7

Treatment for UTI:

Answer 7

• Prompt treatment with Abx (may need IV)
• Ultrasound
• DMSA
• MCUG

Question 8

Organism on culture in UTI:

Answer 8

Typical: E.Coli
Atypical: Klebsiella, Pseudomonas, Proteus

Question 9

DMSA:

Answer 9

• Radioisotope scan (MAG3 similar)
• Shows areas of poor uptake, corelating to poor function, not useful in acute infection
• Indicate scarring or non-functioning anatomy

Question 10

MCUG:

Answer 10

• Micturating cystourethrogram
• Dynamic test looking at urine flowing through renal tract
• Identifies reflux and obstructions
• Fill bladder with contrast and watch micturition flow

Question 11

UTI investigations in <6 month old:

Answer 11

Responds well: USS

Atypical UTI or unwell: USS, DMSA, MCUG

Question 12

UTI investigations in >6 months – 3 years

Answer 12

Responds well: no investigations

Atypical or recurrent: USS, DMSA, MCUG

Question 13

UTI investigations in >3 years

Answer 13

Responds well: no investigations
Atypical UTI: USS
Recurrent UTI: USS, DMSA

Question 14

If abnormalities on Urinary Tract imaging:

Answer 14

• Surgical correction
• Prophylactic abx
• Monitoring renal function / prevent ESRF