Nephro: UTIs in children Flashcards
why are UTIs in children important?
they can lead to scarring or cause comorbidities like HTN, CKD, ESKD
symptoms in UTIs in babies younger than 3 months
- fever
- vomiting
- lethargy
- irritability
- poor feeding
- failure to thrive
- abdominal pain
- jaundice
- haemturia
- offensive urine
symptoms of UTI in preverbal infants
- fever
- abdominal pain
- loin tenderness
- vomiting
- poor feeding
- lethargy
- irritability
- haematuria
- offensive urine
- failure to thrive
symptoms of UTI in verbal infants/children
- frequency
- dysuria
- dysfunctional voiding
- changes to continence
- abdominal pain
- loin tenderness
- fever
- malaise
- vomiting
- haematuria
- offensive urine
- cloudy urine
investigations of a UTIs
- urinalysis (leucocyte esterase and nitrite)
- microscopy (WCC, bacteria)
- gram stain
- culture
how can collect urine?
- suprapubic aspiration
- urinary catheter
- midstream urine
- clean catch
- urine bag
radiology in UTI
- power Doppler ultrasound
- DMSA scan
- DTPA scan
- renal and bladder ultrasound
- magnetic resonance urogram
- CT-KUB
- intravenous urogram
risk factors suggesting a UTI
- renal abnormality
- recurrent unexplained fevers/UTIs
- enlarged kidneys/bladder/poor urine stream
- constipation/dysfunctional voiding
- evidence of spinal lesion
- poor growth
- high BP
- FH of VUR or renal disease
which are the syndromes associated with vesico-urethral reflux
VATER/VACTERL
- vertebral problems
- anal atresia
- cardiac anomalies
- tracheosophageal fistula
- renal anomalies
- limb anomalies
which are the genes that are associated with VUR
- PAX2
- EYE1
- WT-1
what are the types of bladder length?
- long tunnel
- medium tunnel
- short tunnel
which length of ureter predisposes to VUR
short length
when can renal scarring happen in children?
in children with recurrent UTIs and no VUR
pros of a renal ultrasound
- painless, non-invasive, easy
- does not require anaesthesia
- no radiation
- detects all congenital abnormalities
- detects most stones
- indicates any anatomical abnormalities rather than functional
what the gold standard investigation for VUR?
micturating cystourethrogram
criteria for recurrent UTIs in children
- 2 or more upper UTI
- 1 upper or 1 or more lower UTI
- 3 or more lower UTIs
what are atypical findings in UTIs?
- seriously ill, sepsis
- poor urine flow
- abdominal or bladder mass
- raised creatinine
- failure to respond within 48h
- non E.coli UTI
which investigations should you go for in atypical or recurrent UTIs in babies younger than 6 months
- urgent US
- MCUG
- DMSA scan
management of atypical/recurrent UTIs in children aged 6 months to 3 yo
- US (urgent if atypical, non-urgent in recurrent)
- DMSA if atypical or recurrent
- MCUG (only if atypical)
management of atypical/recurrent UTIs in children older than 3yo
- US (urgent if atypical, non-urgent if recurrent)
- DMSA scan (recurrent only)
medical management of upper UTIs
IV antibiotics for 2-3 days, then switch to PO; continue for 7-10 days
medical management of lower UTIs
IV antibiotics for 2-3 days, then switch to PO; continue for 5 days
management for long-term symptoms of UTI
- regular voiding
- treat constipation
- fluids
- circumcisions (recurrent)
- check BP if there are renal defect
- if there are bilateral defects, check protein, renal function and growth yearly
surgical procedures for VUR
- deflux procedure
- re-implantation of ureters
