Pediatric Renal (Newman)

Question 1

Signs and symptoms of UTI in pediatric patients?

Answer 1

Fever
Increased frequency
Increased urgency
Dysuria
Loss of control (dribbling/accidents)

Question 2

Are UTIs more common in girls or boys?

Answer 2

Girls (shorter urethra and distance from urethra and anus - introduces those nasty GI bugs - E. coli)

Question 3

If a child is still in diapers (not potty trained) what is the most reliable way to obtain a urine specimen?

Answer 3

1. Catheterization of the bladder (straight catheter, in and out)
2. Supra-pubic aspiration (needle entered into bladder through the supra pubic region - mainly used in neonates ICU w/ premature babies)

Question 4

Bag urine samples

Answer 4

Bag urine samples are only helpful if negative. They are not appropriate for culture.

Question 5

What is the most common bacterial cause of UTI in children?

Answer 5

Escherichia coli (E. coli)

Question 6

Recommendation imaging for boys with UTI?

Answer 6

First: renal and bladder ultrasound
Then: include Voiding Cystourethrogram (VCUG) if any of the following are present:
1. abnormalities seen on R/B US
2. Combination of temp >102.2F and pathogen other than E. coli
3. Poor growth and HTN
4. Repeated UTIs

Question 7

When is Voiding Cystourethrogram (VCUG) indicated in pediatric patients?

Answer 7

If any of the following are present:
1. abnormalities seen on R/B US
2. Combination of temp >102.2F and pathogen other than E. coli
3. Poor growth and HTN
4. Repeated UTIs

Question 8

Recommended imaging for girls with UTI?

Answer 8

renal and bladder US strongly considered after first UTI, but definitely indicated after the second UTI.
Then: include Voiding Cystourethrogram (VCUG) if any of the following are present:
1. abnormalities seen on R/B US
2. Combination of temp >102.2F and pathogen other than E. coli
3. Poor growth and HTN
4. Repeated UTIs

Question 9

Most common causes of obstructive uropathy in children.

Answer 9

Posterior urethral valves (boys only)
Ureteropelvic junction (UPJ) obstruction

Question 10

Empiric treatment of a child with UTI/pyelonephritis?

Answer 10

must include coverage for the most common UTI pathogen (E. coli)

Question 11

Diagnostic criteria for acute post streptococcal glomerulonephritis?

Answer 11

Classic triad of symptoms (Episodic Hematuria, Edema, HTN)
Hx of preceding strep infection

Question 12

Prognostic indicator of long-term renal damage in children with Henoch-Schonleim Purpura (HSP)?

Answer 12

Protein in urine (along with blood)
-amount of protein is key
-nephrologist should be consulted

Question 13

Hemolytic Uremic Syndrome (HUS) triad

Answer 13

1. Microangiopathic hemolytic anemia
2. Thrombocytopenia
3. Renal insufficiency

Question 14

What is key when obtaining a good urine specimen in pediatric patients?

Answer 14

Cleanliness; child may need help cleaning the area surrounding the urethral opening