Urinary Tract Infection

Question 1

One of commonest bacterial infections

Answer 1

E coli

Question 2

Risk of renal damage

Answer 2

following pyelonephritis those with visco-uteric reflux (VUR) or
obstructive uropathy

Question 3

What are the signs and symptoms of UTI?

Answer 3

• Lower tract: Dysuria, frequent voiding, suprabubic pain

* Upper tract: generally <2years old, fever, loin pain

Question 4

Laboratory tests

Answer 4

Urine Labstix: Albumin +

• Mid-stream urine culture

Question 5

Treatment for UTI

Answer 5

• 1st line – Amipicillin and/or Gentamycin

* 2nd line – Ceftriaxone or cefotaxime

Question 6

What is glomerulonephritis?

Answer 6

• Inflammation of the glomeruli of the kidney
• Most common in children between 5-10 years
• Usually occurs as an immune complex disease
after infection with nepritogenic streptococci
• Tissue damage occurs from a complement

fixation reaction in the glomeruli (antigen-
antibody reactions, plus or obstructs glomeruli)

which affect glomerular filtration rate, leading
to retention of sodium and water in
bloodstream
• Inflammation of the glomeruli increases
permeability allowing protein molecules to
escape into the filtrate

Question 7

The clinical presentation of glomerulonephritis

Answer 7

• Child typically has history of URTI (within 1-2 week) – streptococci infection
• Sudden onset of gross hematuria – tea colored, reddish-brown or smoky
• Proteinuria (Total 24 hour urine) > 1gm
• Urine sediment – WBCs epithelial cells hyaline granular and RBC casts
• May have low grade fever, abdominal pain, edema, vomiting, anorexia or
headache
• Oliguria
• Hypertension from hypervolemia
• Hypoalbuminemia – losing protein in urine

Question 8

What is the treatment?

Answer 8

Symptomatic - strict assessment of intake and output

Question 9

What is nephrotic syndrome?

Answer 9

Fusion of the glomeruli membrane surfaces altered permeability which cause the loss of
protein in urine: May be hypersensitivity to an antigen-antibody reaction or an autoimmune
process

Question 10

What does it usually occurs in children?

Answer 10

• Idiopathic – Most common
• Secondary to glomerulonephritis, sickle cells
anemia or system lupus erythematous
• Congenital

Question 11

What are the characteristics of it?

Answer 11

• Proteinuria
• Oedema
• Hypoalbuminemia
• Hyperlipidemia
(liver compensating protein loss by increase production of lipid)

Question 12

What are the clinical presentation of it?

Answer 12

• Oedema, scrotum oedema in boys
• Ascites – pressure on stomach may lead to anorexia or vomiting
• Diarrhea – due to intestinal oedema which lead to malnutrition caused by poor absorption
• Difficulty in breathing

Question 13

What is the investigation?

Answer 13

• Laboratory test: 24hours urine shows marked proteinuria up to 15gm
• Renal biopsy: done to determine scarring

Question 14

What is the treatment?

Answer 14

Corticosteroids such as oral prednisolone which is titrated according to accomplishment made in
reducing protein loss
• Keep child free of infection while the immune system in suppressed
• Daily weight and urine protein with lab testing strip
• May need diuretic if child is not responding well to prednisolone
- assess electrolytes loss and advice on diet and fluid intake