UTIs

Question 1

Epidemiology of UTIs in <3mos

Answer 1

boys more common than girls <3mo

(if boy <3mo develops UTI >USS as 1/3 have urinary tract abnormality)

(NB asymptomatic bacteruria is common and doesn’t need Rx)

Question 2

organisms causing UTI in children (5)

Answer 2

E. coli

klebsiella

proteus

pseudomonas

enterococcus

Question 3

RFs for childhood UTIs (5)

Answer 3

urinary stasis most common

VUR

obstructive uropathy

neuropathic bladder

habitual infrequent voiding and constipation

Question 4

Presentation of UTIs in childhood (6)

Answer 4

dysuria, frequency

fever +/- rigors

anorexia, lethargy

abdo/loin pain

febrile convulsions

return of enuresis

Question 5

Presentation of UTIs in infants (5)

Answer 5

D+V, lethargy, fever

FTT/poor feeding

prolonged neonatal jaundice

febrile convulsions

septicaemia

Question 6

Ix for UTIs (3)

Answer 6

urine sample:

• clean catch
• pure growth of a single pathogen =/>10^5 colon-forming units/L

in children <3yrs: urgent microscopy

in children >3yrs, urine dip will suffice

Question 7

Mx of UTIs (4)

Answer 7

(begin before culture results and modify accordingly)

if<3mo:

• parenteral Abx and full septic screen
• refer to hospital as may have structural abnormality
• IV Abx

if >3mo:

• Abx as for adults: trimethoprim, nitrofurantoin, cephalosporin or amoxicillin
• if features of pyelonephritis: IV/PO co-amoxiclave or IV cefuroxime

Question 8

UTI prophylaxis and when to give it (3)

Answer 8

trimethoprim/nitrofurantoin

give if:

• VUR
• recurrent UTIs

Question 9

Further Ix for UTIs (3)

Answer 9

USS for renal abnormalities

MCUG

DMSA scan to assess morphology and function of kidneys

Question 10

Options if scarring/reflux is present (5)

Answer 10

circumcision

prophylactic Abx

anti-reflux surgery

annual BP check

monitoring renal growth/function if bilateral defect

Question 11

RFs for VUR (4)

Answer 11

renal dysplasia-foetal malformation

neuropathic bladder

FHx

urethral obstruction

Question 12

Grading reflux

Answer 12

I=mild reflux, ureters only, usually insignificant

III=reflux into renal pelvis

V=reflux into calices, dilated ureters, hydronephrosis. may be assoc. w. intrarenal reflux (increased risk of scarring)

Question 13

Long term consequences of VUR (2)

Answer 13

increased risk of HTN and CKD

Question 14

Ix for VUR (2)

Answer 14

MCUG is diagnostic

DMSA for investigating scarring

(Ix siblings as there is a strong genetic component)

Question 15

Mx of VUR (3)

Answer 15

must be immediate to prevent UTIs

prophylactic Abx

surgery if grade IV/V or recurrent UTIs