Urinary Tract Infection Year 4 Paediatrics Notes OmpathStudy

Urinary Tract Infection Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.2 / MUNGE / RENAL PAEDS -- Slide 1 Urinary Tract Infections Dr Rose Munge Slide 2 Introduction Urinary tract infection (UTI) is one of the most common pediatric infections.\n It distresses the child, concerns the parents, and may cause permanent kidney damage Slide 3 Urinary tract infections (UTIs) commonly occur in children of all ages. UTIs are most common in children under age 1 yr; the prevalence of afebrile symptomatic UTIs in children over age 1 yr is ~8%; the prevalence in febrile infants is 7%.\n During the first yr of life, the male:female ratio is 2.8: 5.4.\n Beyond 1-2 yr, there is a female preponderance, with a male:female ratio of 1: 10. Slide 4 In males, most UTIs occur during the first year of life\n UTIs are much more common in uncircumcised males, especially in the first yr of life, where the rate is 20% in febrile uncircumcised males under age 1 yr.\n In females, the first UTI usually occurs by the age of 5 yr, with peaks during infancy, toilet training, and onset of sexual activity. Slide 5 UTIs are caused primarily by colonic bacteria.\n Escherichia coli causes 54–67% of all UTIs, followed by Klebsiella spp. and Proteus spp., Enterococcus, and Pseudomonas. Other bacteria known to cause UTIs include Staphylococcus saprophyticus, group B streptococcus, and, less commonly, Staphylococcus aureus, Candida spp., and Salmonella spp. Slide 6 UTIs have been considered a risk factor for the development of renal insufficiency or end-stage renal disease in children Many children receive antibiotics for fever without a specific diagnosis (e.g., treating a questionable otitis media), resulting in a partially treated UTI.\n Some children with end-stage renal disease diagnosed as reflux nephropathy actually have dysplasia associated with reflux rather than scarring caused by infection and reflux. Slide 7 Clinical Manifestations and Classification The two basic forms of UTIs (defined as symptoms and a positive culture) are pyelonephritis and cystitis.\n\nFocal pyelonephritis (lobar nephronia) and renal abscesses are less common. Slide 8 Pyelonephritis Pyelonephritis is characterized by any or all of the following:\nabdominal, back, or flank pain; fever; malaise; nausea; vomiting; and, occasionally, diarrhea. Fever may be the only manifestation- temperature 39°C without another source lasting more than 24 hr for males and more than 48 hr for females.\nNewborns can show nonspecific symptoms, such as poor feeding, irritability, jaundice, and weight loss. Slide 9 Pyelonephritis is the most common serious bacterial infection in infants younger than 24 mo of age who have fever without an obvious focus. Involvement of the renal parenchyma is termed acute pyelonephritis, whereas if there is no parenchymal involvement, the condition may be termed pyelitis.\n Acute pyelonephritis can result in renal injury, termed pyelonephritic scarring. Slide 10 Acute lobar nephronia (acute lobar nephritis) is a localized renal parenchymal mass caused by acute focal infection without liquefaction; it more commonly occurs in older children.\nIt may be an early stage in the development of a renal abscess.\nManifestations are identical to those of pyelonephritis and include fever and flank pain. \nRenal abscess typically occurs following hematogenous spread with S. aureus or can occur following a pyelonephritic infection caused by the usual uropathogens.\nMost abscesses are unilateral and right sided and can affect children of all ages.\nBoth acute lobar nephronia and renal abscess are associated with an increased risk of renal scarring. Slide 11 Perinephric abscess can occur secondary to contiguous infection in the perirenal area (e.g., vertebral osteomyelitis, psoas abscess) or pyelonephritis that dissects to the renal capsule.\nIt differs from renal abscess in that it is diffuse throughout the capsule and is not walled off, although it can develop septations.\nAs with renal abscesses, the most common organisms are S. aureus and E. coli.\nA perinephric abscess may not communicate with the collecting system, and, thus, abnormal findings may not be seen on urinalysis or culture. Slide 12 Xanthogranulomatous pyelonephritis is a rare type of renal infection characterized by granulomatous inflammation with giant cells and foamy histiocytes.\n It can manifest clinically as a renal mass or an acute or chronic infection.\n Renal calculi, obstruction, and infection with Proteus spp. or E. coli contribute to the development of this lesion, which usually requires total or partial nephrectomy. Slide 13 Cystitis Cystitis indicates that there is only bladder involvement;\nSymptoms include dysuria, urgency, frequency, suprapubic pain, incontinence, and possibly malodorous urine.\nCystitis does not cause high fever and does not result in renal injury.\nMalodorous urine is not specific for a UTI. Slide 14 Acute hemorrhagic cystitis, though uncommon in ch