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CP2 Paeds - Nephrology and Genitourinary > Urinary tract infection > Flashcards

Urinary tract infection Flashcards

1
Q

Epidemiology of UTIs?

A

3-7% of girls and 1-2% of boys will have at least one symptomatic UTI before 6 years

12-30% will have a recurrence within a year

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2
Q

Difference of symptoms between cystitis and pyelonephritis?

A

Pyelonephritis is usually associated with fever and systemic involvement, where as cystitis there may be no fever

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3
Q

Why is UTI important in childhood?

A
  • up to 50% of pts have a structural abnormality of their urinary tract
  • pyelonephritis may scar and damage the growing kidney, predisposing to hypertension and leading to progressive CKD if scarring is bilateral
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4
Q

Clinical presentation of UTI in infants

A

symptoms are usually non specific

  • fever
  • vomiting
  • lethargy or irritability
  • poor feeding/faltering growth
  • jaundice
  • septicaemia
  • offensive urine
  • febrile seizure (>6 months)
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5
Q

Clinical presentation of UTI in children

A
  • dysuria, frequency and urgency
  • abdominal pain/ loin tenderness
  • fever with/without rigors
  • lethargy and anorexia
  • vomiting and diarrhoea
  • haematuria
  • offensive/cloudy urine
  • febrile seizure
  • recurrence of enuresis
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6
Q

What is dysuria alone usually due to?

A

Cystitis
Vulvitis in girls
Balantitis in uncircumcised boys

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7
Q

Safeguarding thing to consider??

A

Symptoms suggestive of a UTI may also occur following sexual abuse

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8
Q

Methods of collecting urine samples in child in nappies

A
  • clean catch sample when nappy is removed (recommended)
  • urethral catheter
  • suprapubic aspiration
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9
Q

Investigations?

A

Urine sample should be observed under microscope and cultured straight away (indicated in all infants and children <3y with suspected UTI)

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10
Q

When else may urinary white cells be present?

A
  • febrile without UTI
  • balantitis
  • vulvovaginitis
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11
Q

When should urine culture be performed?

A

Always, unless both leucocyte esterase and nitrate are negative, or clinical symptoms and dipstick tests do not correlate

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12
Q

Methods of dipstick testing?

A

Nitrite stick testing

  • +ve result very likely to indicate true UTI
  • some children with UTI are nitrite -ve

Leucocyte esterase stick testing (for WBC)

  • may be present in children with UTI, or negative
  • present in children with febrile illness w/o UTIs
  • +ve in balantits and vulvovaginitis
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13
Q

Leucocyte esterase and nitrite +ve?

A

regard as UTI

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14
Q

Leucocyte esterase -ve and nitrite +ve?

A

start abx treatment if clinical evidence of UTI. Diagnosis depends on urine culture

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15
Q

Leucocyte esterase +ve and nitrite -ve?

A

only start abx treatment if clinical evidence of UTI. diagnosis depends on urine culture

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16
Q

Leucocyte esterase and nitrite -ve?

A

UTI unlikely. Repeat or send urine for culture if clinical Hx suggests UTI

17
Q

Blood, protein and glucose present on stick testing?

A

Useful for other diseases but will not discriminate between child with/without UTI

18
Q

Infecting organisms?

A 
Escherichia coli (Most common)
Klebsiella
Proteus
Pseudomonas
Streptococcus faecalis
19
Q

Risk factors?

A

Renal/urinary tract abnormality
Incomplete bladder emptying
Vesicoureteric reflux

20
Q

Contributing factors to incomplete bladder emptying?

A
  • infrequent voiding, resulting in bladder enlargement
  • vulvitis
  • incomplete micturition with residual postmicturition bladder volumes
  • obstruction by a loaded rectum from constipation
  • neuropathic bladder
  • vesicoureteric reflux
21
Q

What is vesicoureteric reflux (VUR)?

A

Developmental anomaly of the vesicoureteric junctions. Ureters are displaced laterally and enter directly into the bladder rather than at an angle, with a shortened or absent intramural course. Severe cases may be associated with renal dysplasia

22
Q

Risk factors for VUR?

A
  • Familial (30-50% chance of occurring in 1st degree relatives)
  • Secondary to bladder pathology
  • Temporarily after a UTI
23
Q

When do you extensively investigate?

A

Atypical or recurrent UTI

24
Q

Atypical UTI

A
  • seriously ill or septicaemia
  • poor urine flow
  • abdominal or bladder mass
  • raised creatinine
  • failure to respond to suitable antibiotics within 48 hours
  • infection with atypical (non-E.coli) organisms
25
Q

Investigation of atypical UTI

A

Initial ultrasound to identify structural abnormalities/ urinary obstruction/ renal defects

Subsequent Ix depend on USS results

  • MCUG if urethral obstruction is suspected (abnormal bladder in boy)
  • Functional scans should be deferred for 3 months post UTI, unless USS is suggestive of obstruction
26
Q

Management for all infants under 3 months of age

A

Refer to hospital immediately if suspicion of UTI or seriously ill.
- require IV abx (e.g. coamoxiclav) for at least 5-7 days) then oral prophylaxis

27
Q

Management for infants over 3 months and children with acute pyelonephritis/upper UTI

A

Bacteria + fever >38 and loin pain/tenderness with fever <38 is usually treated with
- oral abx (e.g. trimethoprim for 7 days)
- IV abx (e.g. co-amoxiclav) for 2-4 days followed by oral abx for a total of 7-10 days
Choice of abx is adjusted according to sensitivity on urine culture.

28
Q

Management of children with cystitis/lower UTI

A

dysuria with no systemic symptoms or signs can be treated with oral abx such as trimethoprim or nitrofurantoin for 3 days

29
Q

Medical measures for prevention of UTI

A
  • high fluid intake to produce high urine output
  • regular voiding
  • ensure complete bladder emptying “double voiding” by encouraging child to try again after a minute or two
  • treatment and/or prevention of constipation
  • good perineal hygiene
  • Lactobacillus acidophilus, probiotic to encourage colonisation of gut to reduce number of pathogenic organisms
  • Antibiotic prophylaxis (controversial). Often used in those under 2 years - 3 years with congenital abnormality of kidneys/ severe reflux and upper UTI. Trimethoprim (2mg/kg per nocte). Can use nitrofurantoin or cephalexin. Avoid amoxicillin.
30
Q

Diagnostic tests for VUR

A

MCUG - micturating cystourethrogram

DMSA scan?

31
Q

Follow up of children with recurrent UTIs, renal scarring or reflux

A
  • urine dip any non-specific illness
  • long-term, low-dose abx prophylaxis can be used
  • circumcision in boys
  • anti-VUR surgery
  • BP monitoring annually if renal defects are present
  • urinalysis to check for proteinuria (CKD)
  • regular assessment of renal grown and function if bilateral defects (CKD)

CP2 Paeds - Nephrology and Genitourinary (6 decks)

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