UTI -children

Question 1

What can happen if UTI go untreated/unnoticed?

Answer 1

-renal failure

-HTN

Question 2

MCC of UTI in children?

Answer 2

Vesicoureteric reflux -35% of cases

Question 3

what should be done in any ill child coming in the ED?

Answer 3

do urine dip

Question 4

presentation in older kids?

Answer 4

-lower abdominal pain
-dysuria
-frequency
-offensive urine
-haematuria
-fever

Question 5

presentation in children <3 y

Answer 5

-unwell with fever
-irritability, but no specific signs

Question 6

presentation in infants

Answer 6

-poor feeding
-FTT
-vomiting

Question 7

what to look for in an examination?

Answer 7

-always check the BP
-feel for loin tenderness (pyelonephritis) and
abdominal masses (polycystic kidneys)
-Check T°

Question 8

investigation

Answer 8

-urine dip
-urine MCS

Question 9

how to collect urine sample?

Answer 9

-urine collection bag/pad
-suprapubic aspiration

Question 10

How to do the suprapubic aspiration?

Answer 10

Clean the skin with antiseptic solution, then using sterile gloves and an aseptic technique, insert a 21G needle in the midline 2.5cm above the pubic
crest and aspirate urine

Question 11

urine dip findings to suggest UTI in children?

Answer 11

proteins
ketones
nitrites
blood
sugar
bilirubin

Question 12

what is the urine pH in UTI?

Answer 12

4.6 to 8

Question 13

what about nitrites and leu esterase?

Answer 13

positive nitrites are enough to diagnose UTI in children

Leu esterase can be positive as well

Question 14

when to do blood sampling?

Answer 14

-if septicemia
-loin pian
-high grade temp

Question 15

Mgmt: Children with suspected pyelonephritis or who appear toxic

Answer 15

-resuscitate with IV fluids
-IV abx -cefuroxime
-admission

Question 16

when to consider pyelonephritis?

Answer 16

-loin pain and tenderness
-bacteriuria
-Temp of >38C

Question 17

Mgmt: Symptomatic children with abnormal urinalysis (+ve nitrite, proteinuria, or
haematuria)

Answer 17

-3-day course of antibiotics PO (eg trimethoprim or
cefalexin
-encourage plenty of
PO fluids
-complete voiding of urine
-avoid tight underwear
use toilet paper wiping from front to back

Question 18

pediatrics or GP f/u

Answer 18

-chase blood (U&E and glucose) and MCS result
-arrange for outpatient USS or isotope renography and micturating
cysto-urethrography

Question 19

what if the child presents with recurrent UTI with anogenital signs?

Answer 19

consider sexual abuse