RENAL - Urinary Tract Infections

Question 1

What is Acute Pyelonephritis?

Answer 1

Infection of the renal tissue that can lead to scarring and a consequent reduction in kidney function.

Question 2

What is Cystitis?

Answer 2

Infection and consequent inflammation of the bladder.

Question 3

Give 3 Risk Factors for UTIs in Kids.

Answer 3

1. Incomplete Bladder Emptying.
2. Vesicouteric Reflux.
3. Poor Hygiene (not wiping from front-to-back in girls).

Question 4

Give 4 reasons why there may be incomplete bladder emptying in kids.

Answer 4

1. Infrequent Voiding.
2. Hurried micturition.
3. Obstruction due to Constipation.
4. Neuropathic Bladder.

Question 5

What is Vesicouteric Reflux?

Answer 5

A developmental anomaly where the urine has a tendency to flow from the bladder back into the ureters.

Question 6

Epidemiology of Vesicouteric Reflux.

Answer 6

30-35% of children who present with a UTI.

Question 7

Pathophysiology of Vesicouteric Reflux (5).

Answer 7

1. Ureters are displaced laterally and enter bladder more perpendicularly.
2. Shortened intramural course of ureters.
3. Vesicouteric junction will not function adequately.
4. Incomplete bladder emptying.
5. Stagnant Urine = UTI.

Question 8

Grades of Vesicouteric Reflux.

Answer 8

1. Grade I - Reflux into Ureter (no Dilation).
2. Grade II - Reflux into Renal Pelvis on Micturition (no Dilation).
3. Grade III - Mild/Moderate Dilation of Ureter, Pelvis and Calyces.
4. Grade IV - Dilation of Pelvis and Calyces and Moderate Ureteral Tortuosity.
5. Grade V - Grade 4 but with Gross Dilation.

• Grade V is an indication for a surgical referral.

Question 9

Investigations of Vesicouteric Reflux (2).

Answer 9

1. Diagnosis - MCUG.

2. Renal Scarring - DMSA.

Question 10

Management of Vesicouteric Reflux (4).

Answer 10

1. Avoiding Constipation.
2. Avoiding Excessively Full Bladder.
3. Prophylactic Antibiotics.
4. Surgical Input (Paediatric Urology).

Question 11

Give 6 features of an atypical UTI in kids.

Answer 11

1. Non-E.coli cause.
2. Poor Urine Flow.
3. Abdominal/Bladder Mass.
4. Raised Creatinine.
5. Septicaemia.
6. Failure to Respond with Suitable Antibiotics within 48 hours.