Pediatrics: UTI and Pyelonephritis in Children Flashcards
Are pediatric UTI common in children?
Yes
Who does pediatric UTI affect more often?
Females…shorter urethra
Can pediatric UTI occur with normal anatomy?
Yes
What 2 situations increase incidence of pediatric UTI?
- Incidence increases in obstructive conditions: Anatomic or neurogenic (neurodysfunction…cerebral palsy)
- VUR
What is generally the source of pediatric UTI?
Urethral
What roles does the urethra play with regard to UTI?
- Mechanical role: The laminar flow of urine washes out bacterial
- Urethral caliber plays little role if any (how wide it is)
What plays a significant role in UTI with regard to the bladder?
-Frequent and complete bladder empyting
What happens in the bladder from infancy into childhood?
There are changes in storage and emptying patterns
How does the bladder work in an infant?
The bladder reflexively empties when filled to its functional capacity
What are the steps of maturation of bladder control?
- Increase in bladder capacity (holds more urine)
- Perception of bladder fullness while awake
- Perception of bladder fullness while asleep
- Ability to initiate micturition at less than full capacity (2-2.5 years)
- Inhibition of micturition despite a full bladder
What are some normal bladder defenses against infection?
- Frequent and complete emptying (stagnant urine collects bacteria)
- Antibacterial chemical constituents of urine
- Mucous coating of the uroepithelium (blocks bacteria from attaching)
- Laminar flow of urine (clears out bacteria)
What does frequent and complete empyting of the bladder result in?
- Absence of over-distention
2. Maintenance of low pressure in the bladder: Increased pressure results in more strain at the vesicoureteral junction
What are some risks of UTI you must consider?
- Significant residual urine
- High intravesical pressure
- Bladder overdistension
- Infrequent bladder emptying
- Retrograde passage of urine (reflux)
- Fistulae from the GI tract
- Foreign bodies in the urinary tract
Why does constipation significantly correlate with UTI?
It is based on increased bacterial contamination
- Mechanical voiding factors
- Relation between infrequent voiding and constipation: Constipation predisposes to bladder instability
What is encopresis?
Inability to control the elimination of stool
-Multiple etiologies…treat underlying cases
What can mimic symptoms of UTI?
Vaginal or urethral irritation
What are some things that can cause vaginal or uretheral irritation?
- Pinworms: Anal itching
- Bubble baths
- Allergens: Sitting in a bubble bath… can hit the mucous membranes
- Yeast
What are environmental influences that can lead to UTI?
- Holding of urine
- Psychosocial factors
- Indwelling catheters
- Neurogenic bladder
- Urologic instrumentation or surgery
- Renal transplantation
- Diabetes mellitus
- Elevated BP
- Poor growth
- HIV
- General: Anything decrease immune system
What causes 85% of bacterial UTI?
E. COLI
What are other gram-negative bacterial pathogens that can cause UTI?
- Klebsiella
- Proteus
- Pseudomonas
- Enterobacter
- Citrobacter
What are some gram-positive bacterial pathogens that can cause UTI?
- Stapylococcus saprophyticus
- Enterococcus
What are 2 other categories of agents that can cause UTI?
Viral and fungal
What are some pathogens that can cause UTI due to intstrumentation/catheter?
- Pseudomonas species
- Enterococcus species
- Staphylococcus aureus
- Staphylococcus saprophyticus: Coagulase-negative
- Enterobacter species
- Yeast
- Proteus
What can cause UTI in immune compromised patients?
A broad range of organisms
What are clinical features of UTI in neonates?
- Irritability: Can’t console
- Poor feeding
- Failure to gain weight
- Diarrhea: Cross contamination from diaper
- Fever
What are clinical features of UTI in children?
- Urgency: Going often, nothing coming out
- Frequency
- Enuresis: Bed wetting (from being previously potty-trained
- Dysuria
- Fever: No other source
- Failure to toilet train at expected age
What is part of the PE for UTI?
- BP
- Temperature
- Growth paramteres
- Abdominal exam: Suprapubic tenderness or costovertebral angle tenderness
- Genitals: Diaper, allergies, ect.
- Other sources of fever
How must urine sample be collected?
- In a sterile containter: Must be processed within 2 hours
- If refrigerated, processed within 24 hours
Can you give drugs before doing a urine culture?
NO…the drugs with skew the results
How can urine be collected?
- Clean catch: Sterilize area then pee
2. Maybe cath if no other options
If you have a urine sample collected in a sterile specimine container with borate preservative, how long until it should be processed?
24 hours (no refrigeration needed)
What are the 3 types of tests to be done on urine?
- U/A dip: In office
- Urinalysis: Lab
- Urine C/S
What does a urinalysis look for in UTI?
- Leukocytes
- Nitrites
- Blood
- If these 3 are present it is probably a UTI…give them an antibiotic
What does a urine C&S look for to diagnose UTI?
Pyuria: WBC (leukesterase on DIP) and bacteruria