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 : ihab.shaheen@ggc.scot.nhs.uk

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