Date post: | 16-Dec-2015 |
Category: |
Documents |
Upload: | lovingncareing |
View: | 226 times |
Download: | 13 times |
Urinary Tract Infection(UTI)
Ihab ShaheenConsultant Paediatric NephrologistRHSC, Glasgow
Interaction/Informal lecture ( please ask at any time)Feel free to contact me if you have any renal questionMy email : [email protected]
Case16 year old girl, previously wellStarted to wet the bed at nightDysuria,frequency during the dayNo family history of UTIUrinalysisinfection
What next?
Case 28 months maleUnwell, fever, vomitingUrinalysis..infectionA sibling with recurrent UTI
What next?
Objectives:Why important? IncidenceCausesSymptoms/ different age groupDiagnosisInvestigationsTreatmentTo take home
Adult no of nephrons is achieved by 34-35 weeks gestational age
After 34 weeks the nephron mass enlarge by increase tubular length and glomerular size
Glomerular filtration rate (GFR) reach adult level by the end of second year
Incidence:True incidence is uncertain3% in girls and 1% of boys have a symptomatic UTI before the age of 11 years, 50 % of them have a recurrence within a year.
The most important cause of UTI is incomplete bladder emptying due to:Infrequent voidingVulvitisHurried micturitionConstipationVesico ureteric reflux ( VUR)Neuropathic bladder
Organisms:Escherichia Coli in 85%
Proteus ( common in boys)Pseudomonas ( may indicate structural abnormality)Klebsiella and Enterobacter
Symptoms: ( Upper/lower)NeonateLess than 2 yearsOlder children
In neonates symptoms are non specific ( prolonged jaundice)
Septicaemia
Symptoms are non specific in infancy
In the majority of cases full septic screen will be done
In older children symptoms can be divided into:
Upper UTI and Lower UTI
Diagnosis:Urinalysis (methods)
Urine culture
Methods of urinalysisSupra Pubic Aspiration (SPA)
Urine bags
Clean catch
Investigations:US ( Ultrasound)DMSA ( Dimercaptosuccinic acid)MCUG (Micturating cystourethrogram)Most important ( which one?)
US: gives a general idea about renal anatomy, size, major anomalies, good screening tool
DMSA: Dimercapto succinic acidTo be done 6 months after UTIIt is a static testIdentifies scarsGives idea about split renal function
MCUG: Micturating cystourethrogram
Anti physiology
Diagnoses VUR ( vesico ureteric reflux) and gives an idea about the ureters, bladder morphology and urethra
Treatment:Antibiotics (AB)Treat underlying causePrevention Prophylactic AB
Children at risk:Family history of UTI, VURFirst 2 yearsStructural anomaliesFebrile UTI
Prevention:FluidsPrevention or treatment of constipationComplete bladder emptyingGood perineal hygiene in girlsProphylaxis antibiotics?
To take home:Think about UTIUpper UTI vs lower UTIPrevention is the keyIdentify children at riskWhen to investigate?
What is the commonest cause of macroscopic Haematuria?
Aetiology of macroscopic haematuria in 150 children
CauseNumber of childrenUrine infection proven suspectedPerineal irritationTraumaAcute nephritisCoagulopathyStonesTumourOther39351610 6 5 3 135
Simple clinical approachMacromicroHaematuriaisolatedurologyStonePUJ obsructionHaematuria at the start/endHigh BPproteinuriaRenal dysfunctionHistory/investigations suggest glomerular diseaseF/up annuallyBP/ProteinuriaRenal biopsy
Differential diagnosis of generalised oedemaRenal hepaticCardiacAllergicNutritional