UTIs in children

Question 1

Symptoms of UTI

Answer 1

Fever
Suprapubic pain
Vomiting
Dysuria
Urinary frequency
Incontinence

Babies - non-specific symptoms - fever, lethargy, irritability, poor feeding, urinary frequency

Question 2

Important to rule out

Answer 2

Pyelonephritis -

• Temp>38
• Loin pain

Question 3

Investigations

Answer 3

Urine dip from a clean catch urine sample - may be positive for nitrites and leucocytes

MSU - microscopy and culture

FBC, CRP

Question 4

Management of UTI

Answer 4

Under 3m old - immediate IV antibiotics e.g. ceftriaxone and sepsis 6 screen

Consider oral antibiotics if over 3m and otherwise well

IV antibiotics if septic features or pyelonephritis

Antibiotics e.g. trimethoprim, nitrofurantoin, cefalexin, amoxicillin

Question 5

Investigations for recurrent UTIs

Answer 5

Abdominal ultrasound within 6w if recurrent UTIs

DMSA scan - 4-6 m after the illness to assess scarring/damage of the kidneys - DMSA is a radioactive material and a gamma camera is used to see how well this is taken up by kidneys - areas that didn’t take up the material = potential scarring

MCUG (micturating cystourethrogram) - for recurrent or atypical UTIs in children under 6m.

• Can look for Vesico-ureteric reflux
• Involves catheterisation, injecting contrast into the bladder and taking a series of X-rays to assess whether the contrast is refluxing into the ureters

Question 6

What is VUR (vesico-ureteric reflux)?

Management

Answer 6

Where urine has a tendency to flow back to the ureters from the bladder

It predisposes to UTIs and subsequent renal scarring

Management:

• Depends on severity
• Avoid constipation or overfilling bladder
• Prophylactic antibiotics
• Surgical input from urology