UTIs Flashcards
What does a growth of Proteus indicate?
A possible underlying renal cause including a stone
What is the significance of Pseudomonas on culture?
It is difficult to treat and to clear - can lead to neurogenic bladder. A red flag.
What should you do if a child is getting recurrent UTIs and there is a normal US?
US looks for obstruction / hydronephrosis but can not detect reflux or neurogenic bladder therefore still needs referral to assess for an underlying cause
What is the next test that is done for recurrent UTIs and a normal US?
DMSA - shows scarring (rather than function). It is a radio-isotope which is taken up by the renal distal tubular cells
When is an US indicated post UTI according to NICE guidelines?
<6/12, recurrent UTI, atypical UTI in older child
What is the significance of vesico-ureteric reflux?
Reflux mostly resolves on its own by 10 years of age (except grade 5, some of grade 4). The issue is (and whether it requires treatment) whether it is causing recurrent UTIs and whether the bladder is being emptied. Reflux does not damage the kidneys without infection.
What are the two different types of reflux?
Primary: congenital abnormality with VUJ abnormally placed
Secondary: holding on, neurogenic bladder/bladder not emptying, post UTI
Which test diagnoses reflux?
Micturating cystourethrogram (requires anaesthetic and catheterisation)
What is the treatment for reflux?
If it is not causing infections, wait and see. If there are recurrent infections, anatomic anomaly, high grade - surgery (circumcision to reduce infection rate, endoscopic treatment with bulking agents). If mild then may consider circumcision alone.
What are the causes of hydronephrosis?
Mostly PUJ obstruction, could also be VUR. It is difficult to assess for VUR (only on MCUG) - in girls it is often secondary due to holding on, in boys it is often a global disorder e.g. neurogenic bladder. Rare cause is urethral valve (dilated urethra, wetting, haematuria, UTI, failure to thrive)
What should be done if mild-moderate pyelectasis seen on antenatal scan?
Post natal scan but even if this is normal needs follow up scans (3rd and last at 12-18 months). If moderate-severe on postnatal scan needs prophylactic antibiotics until seen by specialist
What is a common presentation of PUJ obstruction?
Chronic abdo pain or nagging sensation. Could present with haematuria due to knock to enlarged kidney (i.e. haematuria not from trauma per se). A normal kidney scan in the past doesn’t rule out.
