Peds Renal HYHO Flashcards
(19 cards)
In which gender are UTIs more common?
girls > boys
What are the signs and sx for a UTI?
fever, frequency, urgency, dysuria, loss of control (accidents, dribbling), nausea, foul smelling urine, dark urine, stomach or suprapubic pain
What are reliable ways to obtain a urine specimen in a child who is not potty trained (still in diapers)?
catheterization of the bladder (straight catheter) or suprapubic aspiration (needle inserted into the bladder through the suprapubic region (mainly used in NICU with premature babies))
How is a urine specimen obtained in a child who is potty trained?
clean catch urine may be used
Bag urine samples are only helpful if what?
negative and they are not appropriate for culture
What is the criteria for diagnosing UTI in a clean catch?
presence of pyuria and at least 50,000 colonies per mL of a single uropathogenic organism
What is the criteria for a UTI diagnosis when using the catheter method for urine sample?
presence of pyuria and colony count of 50,000 or more (can also be 10,000-50,000 which is confirmed by repeat)
What is the criteria for diagnosing UTI when using suprapubic aspiration for the urine sample?
presence of pyuria and any growth on culture
What is the MC bacterial cause of UTI in children?
E coli
What imaging should be performed for a boy after his first UTI?
renal and bladder ultrasound
When should voiding cystourethrogram (VCUG) be performed for a boy or girl?
If any of the following are present: abnormalities seen on RBUS, combination of temp >102.2 and pathogen other than E coli, poor growth and HTN is part of the clinical presentation, repeated UITs
What imaging should be performed after a girl’s first UTI?
RBUS and strongly consider after the second UTI
What are the MCC of obstructive uropathy in children?
posterior urethral valves (boys only) and UPJ obstruction
Pt with VUR have an increased risk for what?
UTI and renal damage; the higher the grade (I-V) the higher the risk; most resolve on their own but grades IV and V usually require surgical repair
Empiric treatment for a child with UTI/pyelonephritis must include coverage for what?
the MC pediatric urinary pathogen (E coli)
What are the indications for referring a patient with a UTI to a specialist?
Cases of dilating VUR (grades III-V), presence of obstructive uropathy, presence of renal anomalies, compromised renal function, HTN associated with UTI, bowel and bladder dysfunction refractory to primary care measures
What is the classic triad of sx for PSGN?
hematuria, edema, HTN
What is the diagnostic criteria for acute PSGN?
Hx of preceding strep infection, elevated ASO, positive anti-DNAse B, recent throat culture positive for strep pyogenes
What is a prognostic indicator for long term renal image in children with HSP?
protein in the urine (along with blood) –> a nephrologist should be consulted
