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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

slide2
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
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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