Pediatric Renal Flashcards
In what gender are UTI’s more common?
Girls
What are the main symptoms of a UTI in a child?
Fever
Suprapubic pain
Urinary urgency/frequency
Loss of control – accidents/dribbling
What is key to obtaining a good specimen of urine collection for culture/sensitivity?
Cleanliness
What is key to obtaining a good specimen of urine collection for culture/sensitivity?
Cleanliness
If a child is not potty trained, what are 2 ways to obtain a urine specimen for culture/sensitivity?
- Straight catheter
2. Supra-pubic aspiration
What is Supra-pubic aspiration and when is it used?
Needle inserted into the bladder through the supra-pubic region to get a urine specimen for culture/sensitivity when a child is not potty trained
– mostly used with neonates in the ICU
Bag urine samples are not appropriate for?
Culture
Main 3 ways to obtain urine for a culture/sensitivity?
Clean catch
Straight catheter
Supra-pubic aspiration
With a clean catch specimen, what is the criteria for a UTI?
Pyuria
> 50K colonies of an organism
With a straight catheter specimen, what is the criteria for a UTI?
Pyuria
10K-50K colonies of an organism
With a supra-pubic aspiration, what is the criteria for a UTI?
Pyuria
ANY growth on culture
What is the most common pathogen for a UTI in children?
E. Coli
What are 2 possible imaging studies used for children with UTI’s?
- Renal and Bladder US
2. Voiding Cystourethrogram
What does a Voiding Cystourethrogram show that a renal and bladder ultrasound cannot?
If there is any reflux from the bladder to kidney
With boys, what should be performed after 1 UTI?
Renal and bladder ultrasound
With boys, after their first UTI, a Voiding Cystourethrogram should be performed if any one of the following 4 things are present?
- Renal and bladder ultrasound anomalies
- Fever > 102.2 and pathogen OTHER than E.coli
- Poor growth and HTN
- Repeated UTI’s
With boys, after their first UTI, a Voiding Cystourethrogram should be performed if one any of the following 4 things are present?
- Renal and Bladder ultrasound abnormalities
- Fever > 102.2 and OTHER pathogen than E.coli
- Poor growth and HTN
- Repeated UTI’s
With girls, when is a renal and bladder ultrasound recommended?
Usually after their 2nd UTI but maybe after the 1st
With girls, a Voiding Cystourethrogram should be performed if any one of the following 4 things are present?
- Renal and Bladder ultrasound abnormalities
- Fever > 102.2 and OTHER pathogen than E.coli
- Poor growth and HTN
- Repeated UTI’s
What are the 2 most common causes of obstructive uropathy in children and which one only occurs in boys?
- Posterior urethral valves – boys only
2. Ureteropelvic junction obstruction
Why is it important to recognize a vesicoureteral reflux?
It can cause UTI’s and renal damage
Most vesicoureteral refluxes will?
Resolve on their own
– Grades 4-5 may need surgery
Empiric treatment of a child with UTI/pyelonephritis must include what coverage?
E.coli
– most common urinary pathogen
What is the common triad of symptoms for Acute Post-Streptococcal Glomerulonephritis?
- Hematuria
- Edema
- HTN
What is the common triad of symptoms for Acute Post-Streptococcal Glomerulonephritis?
- Hematuria
- Edema
- HTN
What is an important item in the history with a child that may have Acute Post-Streptococcal Glomerulonephritis?
History of a recent strep infection
What molecular changes will be present with Acute Post-Streptococcal Glomerulonephritis?
- Anti-streptolysin O titer
- Anti-DNAse B antibody
- Recent throat culture positive for strep pyogenes
What is the prognostic indicator of long-term renal damage in children with Henoch-Schonlein Purpura?
Protein in the urine (along with the blood)
What is the prognostic indicator of long-term renal damage in a child with Henoch-Schonlein Purpura?
Protein in the urine (along with the blood)
