This is an extract of our Renal Problems In Children document, which we sell as part of our Paediatrics Notes collection written by the top tier of University Of Leicester students.
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Renal Problems in Children Urinary Tract InfectionsUTI's are common o Occur in 4% of girls o 1% of boys 90% are due to infection with E.Coli A UTI may indicate a congenital abnormality or vesicoureteric reflux, which if left untreated may lead to renal failure
- Obstructed urinary system o Pelviureteric obstruction o Urinary stenosis o Posterior urethral valves (in boys with poor urinary stream) o Duplex kidney with obstructed pole
- Vesicoureteric reflux o Retrograde flow of urine from bladder up ureters to renal pelvis
- Poor hygiene o Kept in wet nappies o Wiping back to front
- Constipation o Results in poor bladder emptying
HistoryAsk about nonspecific fever, irritability + vomiting esp. in infants Is there dysuria, frequency or bedwetting?
Are there signs of pyelonephritis such as loin pain, vomiting or systemic illness?
Ask about constipation and fluid intake
UTI can present with prolonged jaundice, septic shock or failure to thrive in the neonatal period Is there any tenderness in abdomen or over the kidneys?
Check for palpable kidneys and bladder Always check for BP to exclude secondary renal impairment Examine the spine to exclude neurogenic bladder Examine the urine o Leukocytes, protein + nitrites on dipstick test o MC+S (protein, RBC and organisms on microscopy and gram stain) Abnormal crystals may suggest renal stone disease
Investigations Urine tests
- Pure culture of >10 x 5 CFU wth > 50 white cells per high power view on microscopy confirms a UTI
- Sterile pyuria can occur in any febrile illness or in renal tuborsclerosis or inflammation
- A mixed growth or growth without white cells suggests contamination
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