PEDS GU Flashcards
Most common agent of UTI
E. coli
UTI DDx for kids under 1 yr
<1 yr of age: Anatomic abnormalities, VUR, Uncircumcised male infants
20% of febrile male infants
UTI DDx for kids over 1 yr
> 1 year of age: UTIs seen more in otherwise healthy children → usually girls
Peaks seen in infancy, toilet training, and at onset sexual activity
What is the most common serious bacterial infection in fever without a focus in kids less than 24 months
Pyelonephritis
UTI dx recommendations
AAP recs: catheterization 2-24mo
Clean catch if toilet trained
Perineal bags for urine collection prone to contamination → not recommended for UA or urine culture
What is the gold standard dx for UTI
Urine Culture (UC) Gold standard
Necessary for CONFIRMATION and appropriate therapy
Bacteria or pyuria in UA & ≥ 50,000 CFU/mL of single pathogen on urine culture, in symptomatic child =
UTI
Sensitivity and specificity of Leukocyte esterase and Nitrite for UTI.
70% sensitivity & 99% specificity for UTI
ABX approach to UTI
Oral antibiotics: >6 months of age, not ill-appearing, but positive urine culture -Amoxicilin -TMP/SMX -Nitrofurantoin
Parenteral (IV) antibiotics:
- Toxic/dehydrated-appearing, not tolerating PO
- Ceftriaxone!
Duration parenteral antibiotics:
Neonate: 10-14 days
Older children: 7-14 days
What is the w/u for recurrent UTI
If recurrent UTI: VCUG → vesicoureteral reflux evaluation
If a child is under 1 year of age or no toilet trained with a uti what is the 1st step
Renal/Bladder US → 1st UTI in infants or non-toilet trained children
50% of males w/ VUR present with
50% of males with posterior urethral valves
What is the treatment for a Grade I or II VUR
Grade I & II VUR will likely resolve w/out surgery regardless of age or if unilateral or bilateral
Still refer to nephrologist
Tx for Grade III or higher VUR
Grade III younger age at diagnosis and unilateral higher rate of spontaneous resolution
Nephrology consult
What is the onset of PCKD
Autosomal recessive
Kidney failure usually early childhood (prenatal can be seen)
What is the syndrome most often assoc with Horshoe Kidney
Turner
A young male pt presents with Small, “blue dot” on top of scrotum
Small swelling on upper pole of testicle
Think
Appendiceal torsion
What is the chance of saving the testicle in torsion
Detorsion & fixation of testis
If performed w/in 4-6 hrs of torsion → >90% chance of testicular salvage
Complications of cryptorchidism
Testicular cancer (5 times normal) Infertility (in adulthood)
What is the time frame to refer cryptorchidism to urology
If still undescended at 6 months, refer to Urology
Non communicating hydrocele that persists at 18 month =
Urology referral
W/u for communicating hydrocele
Smallest in the AM, enlarges during the day
Persists
Urology referral for surgical correction
Associated w/ inguinal hernia
10% of hypospadias pts will present with
Undescended testes
MGMT for hypospadias
Urology → surgical correction
Before 18 mos old, ideal age is 6-12mo
NO circumcision !
(foreskin may be needed for repair)
Define enuresis
Definition: urinary incontinence in a child who is adequately mature to have achieved continence
Primary vs secondary enuresis
Primary: incontinence in a child who has never achieved dryness
Secondary: incontinence in a child who has been dry for at least 6 mos
What is the W/u for primary vs secondary enuresis
Primary nocturnal enuresis:
Often a family hx of enuresis and least likely to have identifiable cause
Secondary diurnal & secondary nocturnal enuresis:
More likely organic etiology
(i.e., UTI, DM/polyuria/polydipsia, diabetes insipidus, chronic constipation)
A pt with a negative UA and culture for enuresis should get what additional w/u
Consider renal ultrasound and/or VCUG based on primary vs secondary and diurnal +/- nocturnal
Postive findings would be UTI, DM, and renal Dz
No clinical response w/in 2 days of antimicrobial therapy initiation for UTI →
re-evaluate, repeat urine culture, & undergo prompt imaging—look for abscess, new growth
MC cause of VUR
Causes:
Most common: congenital ureterovesical junction (UVJ) incompetence
-UVJ matures through early childhood
Cystitis or acquired bladder obstruction → bladder outlet obstruction → increased intravesicular pressure
Medical therapy for VUR (In general)
Timed voiding, regular fecal elimination, increased fluid intake, prompt assessment and treatment of UTIs
Better with VUR grades I and II
And surgery Referal to urology
Difference between autosomal dominant and recessive PKD
Dominant: adults onset
Recessive: early childhood
Autosomal recessive PKD
Marked bilateral renal enlargement
Bilteral palpable flank masses, pulmonary hypoplasia,
Kidney failure usually early childhood (prenatal can be seen)
Hepatic fibrosis → portal HTN
Bile duct ectasia & biliary dysgenesis
Flank masses, hepatomegaly, pneumothorax, proteinuria, hematuria
What separates Epidiymo-orchitis and Testicular torsion
Absent or positve prehns sign
Torsion will be absent
A pt presents with Primary Diurnal and Nocturnal enuresis
Think
Neurodevelopmental condition
Bladder function problem
A pt presents with secondary Diurnal and Nocturnal enuresis
Think
UTI
Diabetes mellitus or diabetes insipidus
Rx options for enuresis
Desmopressin :decreases urinary production & safe in enuresis treatment (90% relapse when discontinued)
-Camp, overnight stays at friend’s house
Rarely, imipramine & tricyclic antidepressants
-Nephrology consult warranted
