Fever without a Focus Flashcards
At what gestational age do the kidneys begin to form?
from 5/40
When do glomeruli stop forming in the kidneys of a foetus?
34/40 GA
What is the most common renal anomaly?
Renal Hypoplasia
What happens to the epidemiology of UTI when comparing boys and girls, as an infant and as a child?
Infants - more common in boys than girls
Children - more common in girls than boys
When is the highest incidence of UTI in paediatrics?
In infancy, when the child is under 1 year old
What is the most common UTI pathogen in paediatrics?
E.Coli
What is the prevalence (%) of UTI in females under 16?
12%
What is the prevalence (%) of UTI in males under 16?
4%
When should children have their urine tested?
If they have presented with an unexplained fever of 38°C or higher
This must be done within 24 hours of presentation
This is only if the source of infection is unknown or not obvious to be anything else
What are the 4 most common signs of a UTI in; an infant under 3 months?
- Fever
- Vomiting
- Lethargy
- Irritability
What is the most common sign of a UTI in; an infant/child over 3 months old who is preverbal?
- Fever
What are the 2 most common signs of a UTI in; an infant/child over 3 months old who is verbal?
- Urinary frequency
- Dysuria
What are the 6 less common signs of a UTI in; an infant under 3 months?
- Poor feeding
- Failure to Thrive
- Abdominal pain
- Jaundice
- Haematuria
- Offensive smelling urine
What are the 9 less common signs of a UTI in; an infant/child 3 months and older who is preverbal?
- Abdominal pain
- Loin tenderness
- Vomiting
- Poor feeding
- Lethargy
- Irritability
- Haematuria
- Offensive smelling urine
- Failure to Thrive
What are the 10 less common signs of a UTI in; an infant/child 3 months and older who is verbal?
- Dysfunctional voiding
- Changes in continence
- Abdominal pain
- Loin tenderness
- Fever
- Malaise
- Vomiting
- Haematuria
- Offensive smelling urine
- Cloudy urine
How would you interpret the following dipstick result; leukocyte esterase +ve and Nitrite +ve?
- This child should be regarded as having a UTI
- Abx should be started
- Send the urine for culture if they have a high-intermediate risk of serious illness
How would you interpret the following dipstick result; leukocyte esterase -ve and Nitrite +ve?
- Start Abx if this was definitely a clean catch of urine
- Send the urine for culture - subsequent management will be based off this
How would you interpret the following dipstick result; leukocyte esterase +ve and Nitrite -ve?
- Send the sample for microscopy and culture
- DO NOT start Abx, unless there is good clinical evidence of UTI
- Leukocytes may be a contaminated urine sample indicator
How would you interpret the following dipstick result; leukocyte esterase -ve and Nitrite -ve?
- This child does not have a UTI
- Abx should not be started
- Do not send the urine for culture
When should a urine sample be sent for culture?
- If the child is suspected to have acute pyelonephritis/upper UTI
- Infants and children with a high to intermediate risk of serious illness
- Infants under 3/12
- Any positive on a urine dip
- Recurrent UTI
- Infection unresponsive to Treatment within 24-48h
- When clinical Sx and urine dip do not align
Where would you determine the location of the UTI to be if the child presented with; clinical symptoms, bacteriuria and a fever of 38°C or higher?
Acute pyelonephritis therefore in the kidney or upper urinary tract.
Where would you determine the location of the UTI to be if the child presented with; clinical symptoms and loin pain/tenderness?
Acute pyelonephritis therefore upper urinary tract
Where would you determine the location of the UTI to be if the child presented with; bacteriuria but no systemic features?
Cystitis (bladder) therefore a lower urinary tract infection
When is a UTI classed as recurrent?
- A infant/child has 2< upper UTI’s
- A infant/child has 1 upper UTI and 1< lower UTI’s
- 3< lower UTI’s
What are the features of atypical UTI?
- Seriously ill
- Poor urine flow
- Abdominal or bladder mass
- Raised creatinine
- Septacaemia
- Failure to respond to treatment with suitable Abx in 48 hours
- Infection with non-E.coli organisms
When a child has had a UTI, what investigation needs to be organised at discharge and how long after discharge?
Renal USS in 6/52
Which 3 investigations are selectively used in children with UTI?
- Renal USS
- MCUG
- DMSA
When is a renal USS indicated in a paediatric patient?
- Infant <6 months old with confirmed UTI
2. Children >6 months old ONLY when it is an atypical UTI
What is the purpose of a renal USS?
- Look at the size, shape and location of the kidneys
- Identification of renal pelvic dilatation (hydronephrosis)
What is an MCUG?
Micturating cystogram
When is the use of MCUG indicated in a paediatric patient?
- Infants <6 months old with atypical or recurrent UTI
2. Consider in children >6 months if USS shows dilatation, poor urine flow, non-E.coli infection or FHx of VUR
How is a MCUG carried out?
The child is catheterised, the bladder is filled with radio-contrast agent and then x-rays are taken ad they void urine to see how it is passed.
What can MCUG identify?
Vesicoureteric reflux (VUR)
What is DMSA?
Dimercapto succinic acid is a short-lived radioisotope that goes directly into the kidneys, with a short half-life it only stays in the body for a few hours.
When is a DMSA indicated in a paediatric patient?
- In all children with recurrent UTI
2. In children under 3 years with atypical UTI
What are the characteristics of an Autosomal Dominant Inheritance?
- Males and females are equally as affected
- There are affected individuals present in every generation after a condition has arisen
- In autosomal dominant conditions in general, variable penetrance is common
- In autosomal dominant conditions in general, spontaneous mutations are common
Which medicine therapy is a risk factor for AKI in childhood?
NSAID therapy
Which is the most common cause for AKI in childhood; prerenal, intrinsic renal or postrenal?
Prerenal
