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Morning Report. September 6, 2011. UTIs. Lower Bladder Urethra Upper Kidneys Renal pelvis Ureters. Risk Factors. Age Infants Teenagers Sex First 3 postnatal months Males First 6 years Females. Risk Factors. Previous history Sibling with UTI Catheterization

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Morning report

Morning Report

September 6, 2011


Morning report

UTIs

  • Lower

    • Bladder

    • Urethra

  • Upper

    • Kidneys

    • Renal pelvis

    • Ureters


Risk factors

Risk Factors

  • Age

    • Infants

    • Teenagers

  • Sex

    • First 3 postnatal months

      • Males

    • First 6 years

      • Females


Risk factors1

Risk Factors

  • Previous history

  • Sibling with UTI

  • Catheterization

  • Structural Abnormalities

    • Cause complicated UTIs

  • Most important risk factor for the development of pyelonephritis??

    • VUR


Common bugs

Common Bugs

  • E.coli

    • 90%

  • Enterobacter

  • Proteus

  • Klebsiella


Defense

Defense

  • Empty bladder regularly


Signs and symptoms

Signs and Symptoms

  • Younger children and infants

    • Fever

    • Irritability

    • Poor feeding

    • Lethargy

    • Abd pain

    • Vomiting

    • Loose stools


Signs and sypmtoms

Signs and Sypmtoms

  • Older children/adolescents

    • Cystitis: consist of dysuria, frequency, urgency, suprapubic pain, and/or hematuria

    • Pyelonephritis:consist of the above symptoms (symptoms of cystitis may or may not be present) together with fever (>38ºC), chills, flank pain, costovertebral angle tenderness, and nausea/vomiting

      • May mimic PID


To bag or not to bag

To Bag or Not to Bag?

  • Bag specimen

    • Bag can only exclude if normal, although in younger kids, they may still have UTI and have normal UA

  • Urethral catheterization

  • Suprapubic aspiration

  • Clean Catch

    • Older children


Results

Results

  • Leukocyte esterase

  • WBCs

    • Casts are diagnostic of

      pyelonephritis

  • Nitrites

  • Bacteria

  • Gram stain


Results1

Results

  • Pyelonephritis

    • Elevated peripheral WBC count

    • ESR

    • CRP

    • None are sensitive or specific enough to include or exclude


Results2

Results

  • Culture results

    • Diagnostic confirmation

    • Suprapubic tap

      • Any growth

    • Cath

      • >50,000

    • Midstream Catch

      • >100,000


Imaging

Imaging

  • Not needed to confirm diagnosis of pyelo!

  • U/S

  • CT

    • More sensitive

  • DMSA

    • Test of choice

    • Detects renal scarring

    • Not routinely used


Treatment

Treatment

  • Cystitis

    • Nitrofurantoin

      • *Avoid if suspected early pyleonephritis due to poor plasma concentration

    • TMP-SMX

      • Do not use if local resistance is over 10-20%

    • Fluoroquinolones


Treatment1

Treatment

  • Pyleonephritis


Treatment2

Treatment


Follow up

Follow up

  • No f/u culture needed

  • < 5 years old

    • Antibiotics until work up complete

    • Renal U/S

    • VCUG

    • Older children may warrant eval if febrile UTI or pyelonephritis occurs


Complications

Complications

  • Bacteremia

  • Obstruction

  • Abscess

  • Recurrence

  • Renal Scarring

  • HTN


Noon conference

Noon Conference

Basics of Clinical Teaching, Dr. English

Students off!


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