Introduction to Paediatric Renal disorders and UTIs Flashcards
What percentage of boys and girls will have a UTI by age 11
3% girls
1% boys
What categories are UTIs divided into?
Lower tract, Pyelonephritis, Urosepsis
How might a lower tract UTI present
Dysuria, frequency, abdominal pain, vomiting
Why might a UTI be more difficult to identify in a younger child
Before the child is verbal and or potty trained, it might be difficult to know the pain is associated with urination
How might pyelonephritis present
Unwell, fever and rigors, loin pain, dysuria
How might urosepsis present
Cardiovascular instability/shock
What is the typical organism causing UTI
E. Coli
What is an immediate diagnostic tool for UTI? What would be a positive result
Urine dip-stick test
Leucocytes and nitrites
What can be done to identify the causative organism in UTI
Urine microscopy and culture
Due to the difficulties in collecting urine, what are the alternative options for collection?
Catheter urine
Suprapubic aspiration
What are the risk factors for developing a UTI
Female
Constipation
Neuropathic bladder
Structural abnormalities of the urinary tract
What structural abnormalities of the urinary tract increase risk of UTI
Posterior urethral valves
Vesico-ureteric reflux
What is vesico-ureteric reflux
When the bladder constricts it causes reverse flow of urine into the kidneys, resulting in damage/scarring to the kidneys, and residual urine increases risk of UTI
What is posterior urethral valves
Tissue near the outflow of the bladder causes residual urine to build up, dilatng the bladder and ureters and damaging the kidneys
Whilst oral abx is fine for most children, when is IV administration indicated
When the child is very unwell or very young
What are the atypical organisms in UTI
Klebsiella, Pseudomonas, proteus
What can atypical UTI indicate
An underlying pathology
What are the aims of further investigation in UTI
Identifying renal tract abnormalities
Preventing recurrence
Protecting kidneys in the long term
What investigation looks at the structure and growth of the kidney and what else can it show
Renal USS
Pockets of infection
What radioisotope is used in DMSA
MAG3
What does the DMSA show and what does this indicate
Areas of poor uptake which correlate to poor function (scarring or non-functioning anatomy)
What does MCUG stand for
Micturition Cystourethrogram
What is an MCUG and what can it identify
A dynamic test looking at the flow through the renal tract
Can identify reflux and obstructions
What is the process of an MCUG
Fill the bladder with contrast and then watch the micturition
What are the NICE guidelines regarding a UTI in a child <6 months that responds well to treatment
USS
What are the NICE guidelines regarding a UTI in a child <6 months that is very unwell or has an atypical UTI
USS, DMSA, MCUG
What are the NICE guidelines regarding a UTI in a child 6 months to 3 years that responds well to treatment
No investigations
What are the NICE guidelines regarding a UTI in a child 6 months to 3 years that has an atypical or recurrent UTI
USS, DMSA, MCUG
What are the NICE guidelines regarding a UTI in a child >3 years that responds well to treatment
No Ix
What are the NICE guidelines regarding a UTI in a child >3 years that has an atypical UTI
USS
What is the management plan if an abnormality is detected
Surgical correction
Prophylactic abx
Monitoring to renal function to protect kidneys and anticipate ESRF
