44: Pediatric Renal

Question 1

UTI sx in children

Answer 1

just like in adults - fever, nausea, foul smelling urine, suprapubic pain, frequency, urgency, dysuria, incontinence

Question 2

two best ways to get a urine specimen in a child still in diapers

Answer 2

1. cath the bladder

2. suprapubic aspiration

Question 3

suprapubic aspiration

Answer 3

needle inserted into bladder thru suprapubic abdomen

Question 4

bag urine samples cons

Answer 4

1. only helpful if negative

2. not appropriate for culture

Question 5

UTI Dx criteria in a clean catch sample vs catheter vs suprapubic aspiration

Answer 5

1. clean catch: pyuria + 50,000+ CFU
2. cath: pyuria + 50,000+ CFU
3. suprapubic aspiration: pyuria + any amount of growing culture (low risk of contamination)

Question 6

MC pathogen for UTI in kids

Answer 6

e. coli

Question 7

two MC causes of obstructive uropathy in kids

Answer 7

1. posterior urethral valves (boys only)

2. ureteropelvic junction obstruction

Question 8

significance of VUR (vesico-ureteral reflux) grading

Answer 8

higher grade -> increased risk of UTI, renal damage/scarring

Question 9

treatment for VUR

Answer 9

most resolve on its own, but grades 4 and 5 require surgical repair

Question 10

best prognostic indicator for long-term renal damage in HSP

Answer 10

amount of protein in the urine

Question 11

empiric Abx treatment for UTI in kids

Answer 11

must have coverage for E coli

Question 12

indications to refer a peds pt to a specialist bc of a UTI

Answer 12

1. vesico-ureteral reflux grades 3-5
2. obstructive uropathy
3. renal anomalies
4. compromised renal function
5. HTN
6. bowel and bladder dysfunction