Peds Renal HYHO

Question 1

In which gender are UTIs more common?

Answer 1

girls > boys

Question 2

What are the signs and sx for a UTI?

Answer 2

fever, frequency, urgency, dysuria, loss of control (accidents, dribbling), nausea, foul smelling urine, dark urine, stomach or suprapubic pain

Question 3

What are reliable ways to obtain a urine specimen in a child who is not potty trained (still in diapers)?

Answer 3

catheterization of the bladder (straight catheter) or suprapubic aspiration (needle inserted into the bladder through the suprapubic region (mainly used in NICU with premature babies))

Question 4

How is a urine specimen obtained in a child who is potty trained?

Answer 4

clean catch urine may be used

Question 5

Bag urine samples are only helpful if what?

Answer 5

negative and they are not appropriate for culture

Question 6

What is the criteria for diagnosing UTI in a clean catch?

Answer 6

presence of pyuria and at least 50,000 colonies per mL of a single uropathogenic organism

Question 7

What is the criteria for a UTI diagnosis when using the catheter method for urine sample?

Answer 7

presence of pyuria and colony count of 50,000 or more (can also be 10,000-50,000 which is confirmed by repeat)

Question 8

What is the criteria for diagnosing UTI when using suprapubic aspiration for the urine sample?

Answer 8

presence of pyuria and any growth on culture

Question 9

What is the MC bacterial cause of UTI in children?

Answer 9

E coli

Question 10

What imaging should be performed for a boy after his first UTI?

Answer 10

renal and bladder ultrasound

Question 11

When should voiding cystourethrogram (VCUG) be performed for a boy or girl?

Answer 11

If any of the following are present: abnormalities seen on RBUS, combination of temp >102.2 and pathogen other than E coli, poor growth and HTN is part of the clinical presentation, repeated UITs

Question 12

What imaging should be performed after a girl’s first UTI?

Answer 12

RBUS and strongly consider after the second UTI

Question 13

What are the MCC of obstructive uropathy in children?

Answer 13

posterior urethral valves (boys only) and UPJ obstruction

Question 14

Pt with VUR have an increased risk for what?

Answer 14

UTI and renal damage; the higher the grade (I-V) the higher the risk; most resolve on their own but grades IV and V usually require surgical repair

Question 15

Empiric treatment for a child with UTI/pyelonephritis must include coverage for what?

Answer 15

the MC pediatric urinary pathogen (E coli)

Question 16

What are the indications for referring a patient with a UTI to a specialist?

Answer 16

Cases of dilating VUR (grades III-V), presence of obstructive uropathy, presence of renal anomalies, compromised renal function, HTN associated with UTI, bowel and bladder dysfunction refractory to primary care measures

Question 17

What is the classic triad of sx for PSGN?

Answer 17

hematuria, edema, HTN

Question 18

What is the diagnostic criteria for acute PSGN?

Answer 18

Hx of preceding strep infection, elevated ASO, positive anti-DNAse B, recent throat culture positive for strep pyogenes

Question 19

What is a prognostic indicator for long term renal image in children with HSP?

Answer 19

protein in the urine (along with blood) –> a nephrologist should be consulted