Kidney and Urinary Tract Flashcards
When are UTIs more common in boys?
<3m
How do UTIs present in infants?
poor feeding
vomiting
irritability
How do UTIs present in younger children?
abdo pain
fever
dysuria
How do UTIs present in older children?
dysuria
frequency
haematuria
What are the features suggesting an upper UTI?
Temp >38C
Loin pain or tenderness
What are the Ix of UTI?
urine sample “clean catch”
urine collection bags
catheter or suprapubic aspiration if urgent
in older children - MSU
Presence of WCC , nitrates makes UTI likely
US - detecting reflux
What are the common causative organisms of UTIs?
E. coli (80%) Proteus Pseudomonas Klebsiella Strep. Faecalis
What are the predisposing factors to developing a UTI?
- incomplete bladder emptying:
- infrequent voiding
- hurried/ incomplete micturition
- obstruction by loaded rectum from constipation
- neuropathic bladder - Vesicoureteric reflux (35%)
Why is ureteric dilatation an important problem?
- urine returning to the bladder after voiding results in incomplete voiding encouraging infection
- it can cause pyelonephritis
- renal damage due to bladder voiding pressure can spread to the kidneys
What is the treatment of UTI for <3m?
IV amoxicillin + gentamicin or cephalosporin + ampicillin
What is the treatment of uncomplicated UTIs in >3m
3 days of PO trimethoprim +/- nitrofurantoin/amoxicillin/coamoxiclav
What is the treatment of children >3m with an upper UTI (or acute pyelonephritis)
considered for admission to hospital. If not admitted oral antibiotics such as cephalosporin or co-amoxiclav should be given for 7-10 days
What indicates a lower UTI ?
dysuria and no systemic symptoms
What indicates an upper UTI/ acute pyelonephritis?
bacteriuria + fever >38
or
bacteriuria + loin pain/tenderness
How can UTIs be prevented?
High fluid intake Regular voiding Double micturition Rx of constipation Good perineal hygiene
When is abx prophylaxis considered in UTIs?
w recurrent UTIs
How is scarring minimised in UTIs?
treat as soon as suspected
Why are UTIs potentially serious?
can scar kidney leading to HTN and chronic renal failure
can signify tract abnormality
Why is severe vesicoureteric reflux important?
can cause infrarenal reflux w high risk of scarring if infections occur which can lead to reflux nephropathy which if bilateral can lead to chronic renal failure
