Urinary tract infections and renal disease in children Flashcards
What is the most common presentation for UTI is infants?
Undiagnosed fever. Lethargy, irritability and vomiting may also occur in children younger than 3 months.
What are the most common symptoms of UTI in children older than 2 years?
Dysuria.
Frequency.
What does the diagnosis of UTI require?
Symptoms.
Pyuria (leukocutes in the urine).
Significant bacteriuria.
How is recurrent UTI defined?
Two or more episodes with pyelonephritis.
One episode of pyelonephritis and one or more episodes of cystitis.
Three or more episodes of cystitis.
How is atypical UTI defined?
Severe illness. Septicemia. Raised creatinine. Abdominal or bladder masses. Poor urine flow. Pathogen other than E. coli. No effect of suitable antibiotic treatment after 48 hours.
True or false: A urine bag sample is reliable if positive.
False. A urine bag sample is reliable if negative. (Two samples should be taken before starting treatment with antibiotics.)
What are optional methods of collecting urine samples in children?
Clean catch.
Urine bag sample.
Urine catheter sample.
Supra-pubic aspiration (ultrasound guided).
What is defined as low-grade pyuria in dipstick tests? What does low-grade pyuria indicate?
1-2+.
Low-grade pyuria is unspecific.
What kind of bacteria produce nitrite?
Gram negative bacteria.
True or false: Even if the nitrite-test is negative the possibility of an UTI cannot be excluded in small children.
True. Nitrite-test has a 40-50 % sensitivity for UTI in children under the age of 2 years. In other words, only up to 50 % of children with a UTI will have a positive test.
True or false: Isolated hematuria and/or proteinuria
are not signs of UTI.
True.
What are advantages of urine microscopy compared to urine dipstick test?
In urine microscopy casts (sign of upper UTI), bacteria and leukocytes (and morphology) can be seen. (Has a higher sensitivity as well.)
What are disadvantages of urine microscopy compared to urine dipstick test?
Urine microscopy requires experience and is time consuming. (Has a lower specificity as well.)
What should you ideally do if a dipstick test gives unclear findings?
A urine microscopy to confirm/disprove the diagnosis.
What is likely if there is growth of more than one bacterial species in a urine sample?
Contamination of the sample.
What are some main differences between upper and lower UTIs?
Lower UTI are also known as cystitis, and can be referred to as non-febrile UTI. It gives no renal scarring or effects in renal function as opposed to upper UIT.
Upper UTI are also known as pyelonephritis, and can be referred to as febrile UTI. It causes renal scarring, especially in young children
What findings/factors increase the chance of an upper UTI?
Age < 1 year.
CRP > 50 (high).
Temp. > 38 (fever).
What is it important to remember about children with malformations in the urinary tract or vesicoureteral reflux?
These children are at high of UTIs. Their parents should be informed of this, of symptoms and when to seek medical help.
What can be long term complications of recurrent UTIs?
Decreased renal function, hypertension and complications in pregnancy.
Which children with UTIs should be followed up with further testing and how?
All children < 3 years should be followed up with an ultrasound scan.
Children > 3 years with recurrent UTIs should be followed up with bladder scan or flowmetry, especially if patient history is suggestive of voiding.
What are indications for antibiotic prophylaxis in children with UITs? What antibiotics should be used?
Recurrent infection only. Use either nitrofurantoin or trimethoprim.
Besides antibiotic prophylaxis, what are other preventative measures against UTIs in children?
Urotherapy, e.g. completely emptying the bladder, fluid intake, voiding frequency.
Anti-reflux surgery.
What is characteristic of nephritic syndrome?
Hematuria and proteinuria.
Hypertension.
Reduced GFR / Increased creatinine.
What is characteristic of nephrotic syndrome?
Proteinuria.
Edema (often periorbital).
Decreased albumin.
