UTIs & Bed wetting

Question 1

How would you expect a UTI to present in an infant or child?

Answer 1

neonates will have fever, vomiting, lethargy & irritability (basically non-specific signs)

Children will also complain of abdo/loin pain & tenderness
Along with dysfunctional voiding

Question 2

How do you test for UTI?

Answer 2

Try to get a clean catch urine or midstream urine sample (otherwise a catheter sample or suprapubic aspiration)

• Dipstix (leucocyte/nitrites)
• Microscopy (Pyuria/bacteria)
• Culture(>10^5 colony forming units)

Question 3

What organisms cause UTI in kids?

Answer 3

Most E.coli

Question 4

In what cases of a childhood UTI would you go looking for an underlying cause and how?

Answer 4

• Atypical presentation (e.g. upper tract)
• Young (<6months)
• Recurrent
• Atypical bugs

US for structure & Micturating Cystourethrogram for VUR

Question 5

What scans can you do to check renal scarring/structure?

Answer 5

US for structure
DMSA for scarring
MAG3 (not good in young kids as need continence and to follow instruction)

Question 6

How do you go about treating a UTI in a kid?

Answer 6

Lower tract = 3 days trimethoprim or co-amoxiclav

Upper tract = 7-10 days (IV if systemically unwell)

Question 7

What can you do to prevent further UTIs?

Answer 7

Educate on hygiene and hydration
Look for abnormal tract e.g. VUR
Treat constipation early

Question 8

How would you manage VUR if you found it?

Answer 8

Educate on fluids, hygiene and constipation management
Trimethoprim prophylaxis till 5

STING procedure or Ureteric Reimplantation