Renal/ urology Flashcards
Give 3 causative organisms of UTIs in children
- E coli
- Proteus mirabilis
- Pseudomonas
Give 4 predisposing factors for UTIs in children
- infrequent voiding
- hurried micturition
- not wiping front to back in girls
- vesicoureteric reflux
How does a UTI present in infants
- poor feeding
- vomiting
- irritability
- fever
How does a UTI present in older children
- abdominal pain
- dysuria
- frequency
- haematuria
- smelly/ cloudy urine
- fever
How is a UTI investigated in children
- urine sample: clean catch if possible
- urine collection pads if above not possible
- MSU in older children is suitable
- USS of urinary tract and kidneys
How are UTIs managed in children
- infants <3 months should be referred immediately to a paediatrician
- lower UTI and >3m: oral antibiotics for 3 days - trimethoprim/nitrofurantoin/ amoxicillin/ cefalexin
- Upper UTI - consider admission + oral cefalexin/ co-amoxiclav for 7-10 days
When should an ultrasound of the urinary tract be arranged for children with a UTI
- During acute infection in all children with atypical infection.
- Within 6 weeks for children <6 months with a first-time UTI that responds to treatment.
- For babies and children with non-E. coli UTIs responding well to antibiotics, a non-urgent ultrasound can be requested within 6 weeks.
What indicates an atypical UTI in children
- Seriously ill/Sepsis
- Poor urine flow
- Abdominal/ bladder mass
- Raised creatinine
- Failure to respond to Abx within 48 hours
- Infection with non E coli organism
For children under 3 years with atypical UTI, what scan should be performed to check for renal parenchymal defects and when should this be done?
a dimercaptosuccinic acid (DMSA) scan should be carried out within 4–6 months following the acute infection
How is a recurrent UTI defined in children
- ≥2 episodes of UTI with acute pyelonephritis/upper UTI, or
- 1 episode of UTI with acute pyelonephritis/upper UTI plus ≥1 episode of UTI with cystitis/lower UTI, or
- ≥3 episodes of UTI with cystitis/lower UTI
What is vesicoureteric reflux
developmental abnormality where there is abnormal backflow of urine from the bladder into the ureter and kidney
Explain the pathophysiology of vesicoureteric reflux
- ureters are displaced laterally, entering the bladder in a more perpendicular fashion rather than at an angle
- vesicoureteric junction can’t function properly
How is vesicoureteric reflux investigated
- micturating cystourethrogram (MCUG)
- dimercaptosuccinic acid scan (DSMA) scan to look for renal scarring
How is vesicoureteric reflux managed
- low dose prophylactic antibiotics
- regular monitoring to assess progress
- conservative: avoid constipation, voiding schedules, ensure adequate fluid intake
- surgical input if there’s high grade influx
What is nocturnal enuresis
night time incontinence in a child aged 5 years or older
When do most children achieve day and night time continence
by age 3 or 4
What is primary nocturnal enuresis
when a child has never been consistently dry at night
What is the most common cause of primary nocturnal enuresis in children under 5 years?
a variation of normal development, often with a family history of delayed dry nights.
How is primary nocturnal enuresis typically managed if it’s due to normal development?
Reassurance is important, and there is no need for further investigations or management in these cases.
Other than normal variation, what are some causes of primary nocturnal enuresis?
- Overactive bladder (small volume urination reduces bladder capacity)
- Fluid intake before bedtime, especially fizzy drinks, juice, and caffeine
- Failure to wake due to deep sleep or underdeveloped bladder signals
- Psychological distress (low self-esteem, stress from home/school)
What are some secondary causes of primary nocturnal enuresis?
- Chronic constipation
- Urinary tract infection
- Learning disability
- Cerebral palsy
What is secondary nocturnal enuresis
where a child begins wetting the bed when they have previously been dry for at least 6 months
What are some causes of secondary nocturnal enuresis
- Urinary tract infection
- Constipation
- Type 1 diabetes
- New psychosocial problems (e.g. stress in family or school life)
- Maltreatment
How is nocturnal enuresis managed
- identify causes/ triggers
- reward system (star charts) - for agreed behaviour
- if above not helpful: enuresis alarm - sounds at first sign of bed wetting
- desmopressin for short term control (e.g. sleepovers)
