Urinary Tract Infection

(UTI)

Ihab Shaheen
Consultant Paediatric Nephrologist
RHSC, Glasgow

 Interaction/Informal lecture ( please ask at any time)

Feel free to contact me if you have any renal question
My email : ihab.shaheen@ggc.scot.nhs.uk

Case1

6 year old girl, previously well

Started to wet the bed at night
Dysuria,frequency during the day
No family history of UTI
Urinalysisinfection

What next?

Case 2

8 months male
Unwell, fever, vomiting
Urinalysis..infection
A sibling with recurrent UTI

What next?

Objectives:

Why important?
Incidence
Causes
Symptoms/ different age group
Diagnosis
Investigations
Treatment
To take home

 Adult no of nephrons is achieved by 34-35 weeks

gestational age
After 34 weeks the nephron mass enlarge by increase
tubular length and glomerular size
Glomerular filtration rate (GFR) reach adult level by the
end of second year

Incidence:
True incidence is uncertain
3% in girls and 1% of boys have a symptomatic UTI
before the age of 11 years, 50 % of them have a
recurrence within a year.

The most important cause of UTI is

incomplete bladder emptying due to:

Infrequent voiding
Vulvitis
Hurried micturition
Constipation
Vesico ureteric reflux ( VUR)
Neuropathic bladder

Organisms:
Escherichia Coli in 85%
Proteus ( common in boys)
Pseudomonas ( may indicate structural abnormality)
Klebsiella and Enterobacter

Symptoms: ( Upper/lower)
Neonate
Less than 2 years
Older children

 In neonates symptoms are non specific ( prolonged

jaundice)

Septicaemia

 Symptoms are non specific in infancy

In the majority of cases full septic screen will be done

 In older children symptoms can be divided into:

Upper UTI and Lower UTI

Diagnosis:
Urinalysis (methods)
Urine culture

Methods of urinalysis
Supra Pubic Aspiration (SPA)
Urine bags
Clean catch

Investigations:

US ( Ultrasound)
DMSA ( Dimercaptosuccinic acid)
MCUG (Micturating cystourethrogram)
Most important ( which one?)

 US: gives a general idea

about renal anatomy,
size, major anomalies,
good screening tool

 DMSA: Dimercapto
succinic acid
To be done 6 months
after UTI
It is a static test
Identifies scars
Gives idea about split
renal function

 MCUG: Micturating
cystourethrogram
Anti physiology
Diagnoses VUR ( vesico
ureteric reflux) and gives
an idea about the ureters,
bladder morphology and
urethra

Treatment:

Antibiotics (AB)
Treat underlying cause
Prevention
Prophylactic AB

Children at risk:

Family history of UTI, VUR

First 2 years
Structural anomalies
Febrile UTI

Prevention:

Fluids
Prevention or treatment of constipation
Complete bladder emptying
Good perineal hygiene in girls
Prophylaxis antibiotics?

To take home:

Think about UTI

Upper UTI vs lower UTI
Prevention is the key
Identify children at risk
When to investigate?

What is the commonest cause of

macroscopic Haematuria?

Aetiology of macroscopic haematuria in 150

children
Cause

Number of children

Urine infection
proven
suspected
Perineal irritation
Trauma
Acute nephritis
Coagulopathy
Stones
Tumour
Other

39
35
16
10
6
5
3
1
35

Simple clinical approach

Haematuria
micro

Macro

Stone
PUJ obsruction
Haematuria at
the start/end

urology

History/
investigations
suggest
glomerular
disease

Renal
biopsy

High BP
proteinuria
Renal
dysfunction

isolated

F/up annually
BP/Proteinuria

Differential diagnosis of generalised

oedema

Renal
hepatic
Cardiac
Allergic
Nutritional