what % of boys and girls get UTI before 6 years old
3-7% girls, 1-2% boys
complications pyelonephritis
damage growing kidney by forming a scar- hypertension and chronic renal failure
features UTI in infants
non specific- fever, vomiting, lethargy, poor feeding, jaundice, septicaemia, offensive urine, febrile convulsions
features UTI in children
dysuria and frequency, abdominal pain or loin tendernessm fever +- rigors, lethargy, d +v, haematuria, offensive urine, febrile convulsion, recurring enuresis
what differentiates pyelonephritis from cystitis
fever and systemic involvement
what is the best way to get a urine sample in infant
clean catch
what should you do with urine culture if
culture immediately. or refrigerate
what is the mode of infection in infant
haematogenous (older- bacteria from the gut flora)
commonest organisms UTI
e coli. others- klebsiella, proteus, pseudomonas, strep faecalis
what is vesicoureteric reflux
anomaly vesicoureteric junction. ureters displaced laterally, directly enter into bladder rather than at an angle (backward flow urine from bladder to kidneys)
what is mild VUR
reflex of urine into ureter only. on micturition
what is severe VUR
gross dilatation ureter, renal pelvis and calyces. reflux during bladder filling and voiding. assoc with intrarenal reflux
what has a high risk of causing scarring to the kidneys
intrarenal reflux
if bilateral scarring of kidneys what can occur
chronic renal failure. risk of HTN
when is investigation necessary in UTI
atypical or recurrent UTIs. septicaemia, poor urine flow, abdominal mass, incr creat, failure to respond to antibiotics within 48h. infection with non e coli organisms
investigations in UTI
ultrasound, DMSA (99Tc), MCUG (micturating cystourethrogam), MAG3 renogram, AXR
what is the best investigation for excluding reflux
MCUG
which scan is best for dynamic scan
MAG3
what can be done in first UTI
ultrasound
treatment UTI infant
cefotaxime. or amoxicillin + gentamicin
treatment lower UTI
trimethoprim 3 days. nitrofurantoin
treastment upper UT/ acute pyelonephritis
co amoxiclav for 7-10d or IV cefotaxime 2-4 days then oral for 7-10d
what can be used as prophylaxis
trimethoprim
what can enuresis be due to
lack of attention to bladder sensation, detrusor instability, bladder neck weakness, neuropathic bladder, UTI, constipation, ectopic ureter
presentation ectopic ureter
girls who are dry at night but wet on getting up
investigations enuresis
urine sample, US, urodynamic studies, X ray, MRI
treatment enuresis
desmopressin. enuresis alarm
causes secondary enuresis
when lose previously achieved urinary continence- emotional upset, UTI, polyuria- DM, sickle cell
what is nephrotic syndrome
proteinuria, low albumin, oedema
signs nephrotic syndrome
periorbital oedema, scrotal or vulval leg or ankle oedema, ascites, breathless- effusion
investigations nephrotic syndrome
urine protein, FBC, ESR, U&Es, creat, albumin, complement, urine microscopy and culture, urinary Na, antistrepsolysin O or anti DNAase B titres and throat swab, hep B and C screen
what tests can detect group A strep
anti DNAase b titre, with anti strepsolysin O
what is steroid sensitive nephrotic syndrome
85-90% children with NS respond to corticosteroids. dont progress to renal failure. often precipitated by resp infections
features of steroid sensitive NS
age 1-10y, no macroscopic haematuria, normal bp, normal complement, normal renal function
management steroid sensitive NS
oral prednisolone 60mg/m/d reduce to 40 after 4 weeks then alternate days for 4 weeks then stop.
if steroid sensitive NS doesn’t respond to corticosteroids or atypical what should be done
renal biopsy
what is the most common NS in children
minimal change disease
is minimal change disease responsive to steroid treatment
yes
complication of minimal change disease
hypovolaemia, low urinary Na, thrombosis, infection, hypercholesterolaemia
what can you treat hypovolaemia with in minimal change disease
IV albumin (colloid)
causes of steroid resistant NS
focal segmental glomerulonephritis, mesangiocapillary glomerulonephritis, membranous nephropathy
treatment focal segmental glomerulonephritis
cyclophosphamide, ciclosporin, tacrolimus, rituximab
associations membranous nephropathy
may precede SLE. associated with hep B. most remit spontaneously within 5 years
treatment oedema
diuretics, salt restriction, ACEi, NSAIDs
most common cause haematuria
UTI
signs glomerular haematuria
brown urine, deformed red cells and casts, proteinuria
signs lower UT haematuria
red. beginning or end of stream
when to do renal biopsy in haematuria
significant proteinuria, abnormal renal function, recurrent macroscopic haematuria, complement levels abnormal
non glomerular causes haematuria
trauma, stones, sickle cell, hypercalcuria, bleeding disorders, infection, renal vein thrombosis, tumours
glomerular causes haematuria
acute and chronic glomerulonephritis, IgA nephropathy, thin basement membrane disease, familial nephritis
investigations haematuria
urine microscopy and culture, protein and calcium excretion, US, U&Es, creat, Ca, PO4, albumin, FBC, platelets, clotting, sickle cell screen
if suspect alports what can you test
hearing
what is henoch schlonein purpura
acute immune complex mediated vasculitis
what precedes the purpura in HSP
URTI
symptoms HSP
purpura, arthritis/arthralgia, abdominal pain. renal involvement- glomerulonephritis, haematuria, proteinuria. intussusception, GI petechiae- haematemesis and malaena
presentation HSP
symmetrical rash over buttocks, extensor surfaces of arms and legs, ankles. trunk spared. usually have a fever. 3-10y. male : female 2:1
tests in HSP
ESR incr, IgA incr, proteinuria, ASO titres incr, U&E, BP.
complications HSP
massive GI bleeds, haemoptysis, acute renal failure
what is AKI characterised by
rapid rise in creat and development oliguria/anuria
what is haemolytic uraemic syndrome
acute microangiopathic haemolytic anaemia, thrombocytopaenia, renal failure + endothelial damage to glomerular capillaries.
what is typical HUS associated with
diarrhoea. more freq in summer months, typically occurs children
