Genitourinary Disorders in Children Flashcards
Three Types of UTIs in Children
asymptomatic bacteriuria: bacteria/no symptoms
-benign doesn’t cause renal injury
cystitis: lower tract symptoms (bladder)
pyelonephritis: most severe; involves kidneys; can cause irreversible renal damage
UTI: Clinical Manifestations
infants:
- fever
- irritability
- vomiting
children:
- fever
- bacteriuria
- vomiting
- flank pain in children
complicated UTI = w/
- fever
- toxicity
- dehydration
- or any UTI in child under 3-6 months
UTI: S/Sx
- foul smelling urine
- dysuria
- fever
- hematuria (may also be cloudy)
- abdominal/back pain (mid to low)
- n/v/d
- irritable
- decreased PO
- urinary urgency
- urinary frequency
UTI: Classificiations
may be classified by structural or functional abnormality
- vesicoureteral reflux
- obstruction
- dysfunctional voiding
- pregnancy
UTI and Pyelonephritis: RF
- organism most commonly E. coli
- short female urethra
- poor perineal hygiene
- presence of pinworms
- bubble baths
- constipation
- urethral instrumentation
- inadequate/infrequent voiding
- weight
- urinary tract obstruction or anomalies
Urinary Tract Infection and Pyelonephritis: Clinical Findings
- family hx of VUR, recurrent UTI
- prenatally diagnosed real abnormality
- previous infection
- circumcision
- hygiene
- constipation
- perianal itching
- irritants
- high blood pressure
- sexual activity
- masturbation
- abuse
- other infections (pinworms, diaper rash)
UTI and Pyelonephritis: Dx
-urine culture: positive if -
>100,000 in clean catch
>50,000 in catheterize/suprapubic
> or equal to in 10,000 in symptomatic child
bacterial identification/sensitivity necessary in:
- toxic patients
- those with pyelonephritis
- recurrent UTI
- non-responsive to medication
UTI and Pyelonephritis: Tx uncomplicated cystitis
short-term (3-5 days) antibiotics
children (2-24 month) and febrile children should have 7-10 days of antibiotics
Antibiotics:
- TMP-SMX
- amoxicillin
- amoxicillin-clavulanate
- cephalixin, cefixime, cefpodoxime
- ciprofloxacin
- nitrofurantoin
UTI and Pyelonephritis: Tx Recurrent UTI
- further evaluation required
- prophylactic antibiotics controversial
UTI and Pyelonephritis: Tx Acute Pyelonephritis
- oral therapy as effective as parenteral
- hospitalization depends on severity of symptoms
- young children: cefixime ceftibutin, amoxicillin-clavulanate
- adolescents: amoxicillin-clavulanate, ciprofloxacin
UTI and Pyelonephritis: Patient and Family Education, Prevention, Prognosis
- cause, complication, tx plan
- frequent/complete voiding; increase fluids
- tx constipation or pinworms
- sexual active females - void after intercourse
- decrease intake of bladder irritants
- prompt medical attention for fever
- cranberry juice helpful
Vesicoureteral Reflux (VUR)
- regurgitation of urine from bladder into ureters and potentially to kidneys
- exposure to infected urine and pyelonephritis
- primary VUR: shorter ureter; ineffective valve
- secondary VUR: bladder outlet obstruction
VUR: Grading
- Grade I: does not reach renal pelvis
- Grade II: up to renal pelvis w/o dilation
- Grade III: renal pelvis; mild/moderate dilation
- Grave IV and V: distension of ureters/renal pelvis; hydronephrosis or reflux into intrarenal collecting system
VUR: Management
- prevent infections/scarring
- very few require surgery
- treat underlying comorbidities (constipation, dysfunctional voiding)
- prophylactic antibiotics may be used
- interval urine cultures when symptomatic
- repeat VCUG 12-18 months
- nephrology consultation w/ higher grade reflux, scarring, solitary or atrophic kidney, hypertension, evidence of abnormal kidney function
