Urinary Tract Infection (1).ppt
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Transcript of Urinary Tract Infection (1).ppt
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Urinary Tract Infection(UTI)
Ihab ShaheenConsultant Paediatric NephrologistRHSC, Glasgow
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Interaction/Informal lecture ( please ask at any time)Feel free to contact me if you have any renal questionMy email : [email protected]
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Case16 year old girl, previously wellStarted to wet the bed at nightDysuria,frequency during the dayNo family history of UTIUrinalysisinfection
What next?
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Case 28 months maleUnwell, fever, vomitingUrinalysis..infectionA sibling with recurrent UTI
What next?
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Objectives:Why important? IncidenceCausesSymptoms/ different age groupDiagnosisInvestigationsTreatmentTo take home
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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
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Incidence:True incidence is uncertain3% 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.
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The most important cause of UTI is incomplete bladder emptying due to:Infrequent voidingVulvitisHurried micturitionConstipationVesico ureteric reflux ( VUR)Neuropathic bladder
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Organisms:Escherichia Coli in 85%
Proteus ( common in boys)Pseudomonas ( may indicate structural abnormality)Klebsiella and Enterobacter
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Symptoms: ( Upper/lower)NeonateLess than 2 yearsOlder children
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In neonates symptoms are non specific ( prolonged jaundice)
Septicaemia
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Symptoms are non specific in infancy
In the majority of cases full septic screen will be done
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In older children symptoms can be divided into:
Upper UTI and Lower UTI
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Diagnosis:Urinalysis (methods)
Urine culture
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Methods of urinalysisSupra Pubic Aspiration (SPA)
Urine bags
Clean catch
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Investigations:US ( Ultrasound)DMSA ( Dimercaptosuccinic acid)MCUG (Micturating cystourethrogram)Most important ( which one?)
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US: gives a general idea about renal anatomy, size, major anomalies, good screening tool
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DMSA: Dimercapto succinic acidTo be done 6 months after UTIIt is a static testIdentifies scarsGives idea about split renal function
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MCUG: Micturating cystourethrogram
Anti physiology
Diagnoses VUR ( vesico ureteric reflux) and gives an idea about the ureters, bladder morphology and urethra
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Treatment:Antibiotics (AB)Treat underlying causePrevention Prophylactic AB
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Children at risk:Family history of UTI, VURFirst 2 yearsStructural anomaliesFebrile UTI
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Prevention:FluidsPrevention or treatment of constipationComplete bladder emptyingGood perineal hygiene in girlsProphylaxis antibiotics?
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To take home:Think about UTIUpper UTI vs lower UTIPrevention is the keyIdentify children at riskWhen to investigate?
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What is the commonest cause of macroscopic Haematuria?
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Aetiology of macroscopic haematuria in 150 children
CauseNumber of childrenUrine infection proven suspectedPerineal irritationTraumaAcute nephritisCoagulopathyStonesTumourOther39351610 6 5 3 135
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Simple clinical approachMacromicroHaematuriaisolatedurologyStonePUJ obsructionHaematuria at the start/endHigh BPproteinuriaRenal dysfunctionHistory/investigations suggest glomerular diseaseF/up annuallyBP/ProteinuriaRenal biopsy
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Differential diagnosis of generalised oedemaRenal hepaticCardiacAllergicNutritional