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Morning Report

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

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  1. Morning Report September 6, 2011

  2. UTIs • Lower • Bladder • Urethra • Upper • Kidneys • Renal pelvis • Ureters

  3. Risk Factors • Age • Infants • Teenagers • Sex • First 3 postnatal months • Males • First 6 years • Females

  4. Risk Factors • Previous history • Sibling with UTI • Catheterization • Structural Abnormalities • Cause complicated UTIs • Most important risk factor for the development of pyelonephritis?? • VUR

  5. Common Bugs • E.coli • 90% • Enterobacter • Proteus • Klebsiella

  6. Defense • Empty bladder regularly

  7. Signs and Symptoms • Younger children and infants • Fever • Irritability • Poor feeding • Lethargy • Abd pain • Vomiting • Loose stools

  8. 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

  9. 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

  10. Results • Leukocyte esterase • WBCs • Casts are diagnostic of pyelonephritis • Nitrites • Bacteria • Gram stain

  11. Results • Pyelonephritis • Elevated peripheral WBC count • ESR • CRP • None are sensitive or specific enough to include or exclude

  12. Results • Culture results • Diagnostic confirmation • Suprapubic tap • Any growth • Cath • >50,000 • Midstream Catch • >100,000

  13. Imaging • Not needed to confirm diagnosis of pyelo! • U/S • CT • More sensitive • DMSA • Test of choice • Detects renal scarring • Not routinely used

  14. 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

  15. Treatment • Pyleonephritis

  16. Treatment

  17. 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

  18. Complications • Bacteremia • Obstruction • Abscess • Recurrence • Renal Scarring • HTN

  19. Noon Conference Basics of Clinical Teaching, Dr. English Students off!

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