Nephro: UTIs in children Flashcards
(24 cards)
why are UTIs in children important?
they can lead to scarring or cause comorbidities like HTN, CKD, ESKD
symptoms in UTIs in babies younger than 3 months
- fever
- vomiting
- lethargy
- irritability
- poor feeding
- failure to thrive
- abdominal pain
- jaundice
- haemturia
- offensive urine
symptoms of UTI in preverbal infants
- fever
- abdominal pain
- loin tenderness
- vomiting
- poor feeding
- lethargy
- irritability
- haematuria
- offensive urine
- failure to thrive
symptoms of UTI in verbal infants/children
- frequency
- dysuria
- dysfunctional voiding
- changes to continence
- abdominal pain
- loin tenderness
- fever
- malaise
- vomiting
- haematuria
- offensive urine
- cloudy urine
investigations of a UTIs
- urinalysis (leucocyte esterase and nitrite)
- microscopy (WCC, bacteria)
- gram stain
- culture
how can collect urine?
- suprapubic aspiration
- urinary catheter
- midstream urine
- clean catch
- urine bag
radiology in UTI
- power Doppler ultrasound
- DMSA scan
- DTPA scan
- renal and bladder ultrasound
- magnetic resonance urogram
- CT-KUB
- intravenous urogram
risk factors suggesting a UTI
- renal abnormality
- recurrent unexplained fevers/UTIs
- enlarged kidneys/bladder/poor urine stream
- constipation/dysfunctional voiding
- evidence of spinal lesion
- poor growth
- high BP
- FH of VUR or renal disease
which are the syndromes associated with vesico-urethral reflux
VATER/VACTERL
- vertebral problems
- anal atresia
- cardiac anomalies
- tracheosophageal fistula
- renal anomalies
- limb anomalies
which are the genes that are associated with VUR
- PAX2
- EYE1
- WT-1
what are the types of bladder length?
- long tunnel
- medium tunnel
- short tunnel
which length of ureter predisposes to VUR
short length
when can renal scarring happen in children?
in children with recurrent UTIs and no VUR
pros of a renal ultrasound
- painless, non-invasive, easy
- does not require anaesthesia
- no radiation
- detects all congenital abnormalities
- detects most stones
- indicates any anatomical abnormalities rather than functional
what the gold standard investigation for VUR?
micturating cystourethrogram
criteria for recurrent UTIs in children
- 2 or more upper UTI
- 1 upper or 1 or more lower UTI
- 3 or more lower UTIs
what are atypical findings in UTIs?
- seriously ill, sepsis
- poor urine flow
- abdominal or bladder mass
- raised creatinine
- failure to respond within 48h
- non E.coli UTI
which investigations should you go for in atypical or recurrent UTIs in babies younger than 6 months
- urgent US
- MCUG
- DMSA scan
management of atypical/recurrent UTIs in children aged 6 months to 3 yo
- US (urgent if atypical, non-urgent in recurrent)
- DMSA if atypical or recurrent
- MCUG (only if atypical)
management of atypical/recurrent UTIs in children older than 3yo
- US (urgent if atypical, non-urgent if recurrent)
- DMSA scan (recurrent only)
medical management of upper UTIs
IV antibiotics for 2-3 days, then switch to PO; continue for 7-10 days
medical management of lower UTIs
IV antibiotics for 2-3 days, then switch to PO; continue for 5 days
management for long-term symptoms of UTI
- regular voiding
- treat constipation
- fluids
- circumcisions (recurrent)
- check BP if there are renal defect
- if there are bilateral defects, check protein, renal function and growth yearly
surgical procedures for VUR
- deflux procedure
- re-implantation of ureters
