UTI:

Question 1

What commonly causes UTIs in children?

Answer 1

E. coli

Question 2

How do UTIs typically present in children?

Answer 2

Non-specifically - fever, poor feeding, irritability, vomiting (the younger the child the less specific)

Question 3

What is the gold standard diagnosis of UTIs in children?

Answer 3

Pyuria (puss in urine) with pur growth of 105 colony forming units per ml

Question 4

What can sometimes be the underlying cause of UTIs?

Answer 4

Obstruction

Vesico-ureteric reflux

Question 5

Give 4 risk factors for UTIs in children:

Answer 5

• Output issues: poor urine flow, constipation or dysfunctional voiding
• FH: of vesicoureteric reflux or renal disease
• Examination: faltering growth/hypertension
• Evidence of spinal lesion

Question 6

What does bacteruria, fever of 38 or more, loin pain suggest?

Answer 6

Acute pyelonephritis

Question 7

How long should treatment of acute pyelonephritis be? How does this compare with a normal UTI?

Answer 7

7 days (normally 3)

Question 8

What will be seen on urine dip in a UTI?

Answer 8

Protein and blood-non-specific
Leucocyte esterase
Nitrities
^WCC
(clean catch MC+S should be done to confirm)

Question 9

What should prompt investigation into the cause of the UTIs?

Answer 9

• One or more UTIs in first 6 months of life

- 2 or more UTIs in children over 6 months

Question 10

What investigations can be performed in renal/bladder pathology is suspected?

Answer 10

USS - detect structural abnormalities (horse shoe kidney, duplex kidney), Can detect obstruction (causing hydronephosis and dilated renal calyces)

DMSA scan - parenchymal damage (renal scarring). Radio isotope that binds to proximal tubules giving clear picture of kidney anatomy. Should be delayed for a few months after an acute infection as recent infection ca affect validity of results