What might be the only CF of UTI in kids?
Fever
Who has very vague non-specific symptoms, kids or babies?
Babies
What are the CF of UTI in BABIES? (6 things)
- Fever
- Lethargy
- Irritability
- Vomiting
- Poor feeding
- Urinary frequency
What are the CF of UTI in KIDS? (6 things)
- Fever
- Abd pain (esp suprapubic pain)
- Vomiting
- Dysuria
- Urinary frequency
- Incontinence
What CF are needed for a Dx of Acute Pyelonephritis? (2 things)
- Temp 38+
- Loin pain / tenderness
What investigation can you do for sus UTI?
Urine dipstick
What are you looking for in Dipstick of sus UTI? (2 things)
- Nitrites
- Leukocytes
Which is more indicative of UTI, Nitrites or Leukocytes?
Nitrites
If only Nitrites are present in dipstick, what should you do?
Tx as UTI
If only leukocytes are present in dipstick, what should you do?
Send urine to microbiology
What should you do for all children under 3 months w fever? (3 things)
- Immediate IV abx (e.g ceftriaxone)
- Full septic screen
- Consider lumbar puncture
What should you do for children over 3 months w fever, otherwise well?
ORAL abx
What Abx can you use for UTI kids? (4 things)
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin
What investigations does NICE recommend you do for Recurrent UTIs in kids? (3 things)
- US
- DMSA scan
- Micturating Cystourethrogram (MCUG)
What are the recommendations of NICE for US scans on UTI kids? (3 things)
- All babies under 6 months w first UTI –> Abd US
- Recurrent UTIs –> Abd US within 6 wks
- Atypical UTIs –> Abd US during illness
When should you do a DMSA scan for recurrent UTIs?
4-6 months after illness to assess for damage
What does DMSA scan show you in recurrent UTIs?
Scarring in kidney as a result of inf
What are you looking for with a Micturating Cystourethrogram (MCUG) for Recurrent UTIs?
Vesico-Ureteric Reflux (VUR)
Who should you do a Micturating Cystourethrogram (MCUG) on? (4 things)
- Baby under 6 months w UTI
- FHx Vesico-Ureteric Reflux (VUR)
- Dilatation of ureter on US
- Poor urinary flow
What is Vesico-Ureteric Reflux (VUR)?
Urine likes to flow from bladder –> bk to ureters
What does having Vesico-Ureteric Reflux (VUR) predispose the kid to?
Recurrent Upper UTIs –> Renal scarring
What are the Mx options for Vesico-Ureteric Reflux (VUR)? (4 things)
- Avoid constipation
- Avoid excessively full bladder
- Prophylactic abx
- Surgical input from paeds urology
