UTIs

Question 1

How do they present in a neonate?

Answer 1

• Fever
• Vomiting
• Lethargy
• Irritability
• Poor feeding
• FTT
• Offensive urine
• Abdominal pain
• Jaundice
• Haematuria

Question 2

How do they present in children?

Answer 2

Pre-verbal

• Fever
• Abdominal pain
• Tenderness
• Vomiting
• Poor feeding
• Lethargy
• Irritability
• Haematuria
• Offensive urine
• FTT

Verbal

• Frequency
• Dysuria
• Dysfunctional voiding
• changes to continence
• abdominal/ loin pain or tenderness
• cloudy/ foul smelling urine

Question 3

Investigations

Answer 3

Dipstix

• Nitrates
• Leucocytes
• pyuria
• Bacturia

US 
Renogram
MAG3: drainage/ function/ reflux 
DMSA: function/ scarring 
Micturatingh cytourethrogram: only ever done under anaesthetic

Question 4

Treatment of VUR

Answer 4

• Hydration
• Avoid bubble bathes
• Clean perineum from front to back
• Prevent constipation

Question 5

Complications of VUR

Answer 5

• Renal scarring

Question 6

Investigations post up

Answer 6

• Renal USS
• DMSA: isotope scan for scarring
• MCUG if young
• MAG3 if older

Question 7

Antibiotics

Answer 7

If <3months

• IV amoxycillin + gentamicin
• IV cephalosporins + ampicillin

If >3months and uncomplicated

• 3 days of trimethroprim or
• Nitrofuratoin/ amoxycillin

If complicated
- Gentamycin

Question 8

Grading of VUR?

Answer 8

1-5
1: in urethra
2-4: in renal pelvis and calyces
5: in the renal ureter