Can't dx vesicourethral reflux(VUR) which is a big reason for recurrent UTI in children
What is a disadvantage of renal ultrasonography for PEDS?
This imigaing can be used to:Assess anatomy of urinary tract
Collecting system abnormalities
Limited detection of anatomic kidney abnormalities
Requires use of contrast and radiation
What imaging? Evaluation of lower urinary tract
Evaluates for vesicoureteral reflux, posterior urethral valves
Requires insertion of urethral catheter
Surgery is needed for correction
What is treatment for posterior urethral valves in males?
What imaging?Used very rarely
Eval mass seen on U/S, persistent urinary symptoms
In children, UTIs can cause renal scarring which may lead to HTN and chronic renal insufficiency
What is significance for UTI's in peds?
Infants: fever, vomiting, anorexia, failure to thrive, irritability, asymptomatic jaundice
Ages 2-5: abdominal pain, fever, enuresis, may have frequency/urgency
Ages 5 and older: "classic" signs-dysuria, frequency, urgency, possibly CVAT
What are these signs of?
If a child has fever of 103-105 w/no other symptoms, always check for_____?
Present in ~1% of population
Retrograde urine flow from bladder to kidneys
Due to defective valve
Usually bilateral in children. This may correct itself. Does not always need surgery.
_________can also be associated with the use of bubble bath or perfumed soaps.
To help rule out neurogenic bladder and spina bifida.
Why would you check for a "sacral fat pad" in children w/UTI?
Newborn to 30 days - septic evaluation including catheterized UA and UC in hospital.
Admit your patient if less than 30 days of life or if child is dehydrated or appears septic
What is the UTI workup for ped under 30 days old?
Cath. UA or suprapubic aspiration and UC
What is the UTI workup for peds 1-24 months old?
renal ultrasonography...Advise providers to consider voiding cystourethrography
Boys with first UTI - detect posterior urethral valves
Suspected urologic abnormality-weak stream, perineal abnormality
What do you do w/children 2 months to 2 years with first febrile UTI
What do you do for for pyelonephritis not improving with appropriate abx after 3-5 days
Diagnosis of UTI is based on culture indicating more than 10 to the ____ colonies/ml of a single organism or 10 to the ____
for catherized specimen.
Trimethoprim/sulfamethoxazole (Septra, Bactrim), Cefprozil (Cefzil), Cefixime (Suprax), and Amoxicillin are good initial choices.
May need to change abx once UC and S received. Amox is 1st choice.
Meds for UTI in children?
Treatment of uncomplicated cystitis in pediatrics: ______
Treatment of pyelonephritis in peds?
Remember to check for pregnancy if indicated and choose your antibiotic accordingly.
Surgical correction if grade IV or V
Antibiotic prophylaxis for lower grades
Monitor annually for resolution
Treatment for VUR?
YES. ALWAYS!!! Re-evaluate your patient and repeat the UA in two weeks.
Do you follow up a UTI?
Monitoring Bun/creatine. Creatine doubling= 50% reduction in GFR
How can you dx acute renal failure?
Most common cause of acute renal failure in peds?
Severe untreated vesicoureteral reflux nephropathy
Causes of chronic renal failure in peds?
60% of cases in children 2-12
Signs/Symptoms: hematuria, edema, HTN, oliguria
Diagnosis: UA shows blood, protein, RBC casts ; elevated ASO titer, decreased complement (C3, C4), elevated creatinine and BUN
Treatment: decrease sodium intake, diuretics
Course: usually self-limited; occasionally progressive or persistent beyond 12 months (warrants renal biopsy)
Follow-up: at regular intervals for 12 months-monitor BP and UA
IgA Nephropathy (Berger's Disease)
Most common glomerulonephritis worldwide
Signs/Symptoms: asymptomatic gross hematuria with a minor febrile illness (URI), possible HTN, edema
IgA Nephropathy (Berger's Disease)
Diagnosis: UA shows blood and proteinuria <1 gm/day, elevated serum IgA, elevated BUN and creatinine, complement levels normal
Course/Treatment: usually resolves within days-no treatment needed-may have recurrences; if HTN or more significant proteinuria present, BP needs to be controlled and corticosteroids may be used
Signs/symptoms: rash on extremities, arthralgias, abdominal pain, bloody diarrhea, hematuria, possible HTN
Likely due to IgA deposition in affected tissues-vasculitis affecting skin and mucous membranes
Diagnosis: UA-hematuria, proteinuria <2 gm/d, serum IgA level elevated
Course: generally self-limited 4-16 weeks, some have recurrences
Treatment: corticosteroids for renal disease, not for dermal/GI/joint symptoms
Follow-up: monitor renal function for years
Signs/symptoms: Prodrome of abdominal pain, diarrhea, vomiting followed by HTN, edema, oliguria, GI bleeding
Usually result of infection with Shigatoxin-producing organism-toxin damages endothelium leading to microthrombi and red cell fragmentation
Diagnosis: UA shows proteinuria; anemia, thrombocytopenia, elevated bilirubin
Treatment: supportive-maintain fluid and electrolyte balance, control HTN, transfusion if necessary
Prognosis: recovery from acute episode in weeks, 30% have persistent renal disease.
Follow-up: monitor renal function for 1-2 years, monitor BP for 5 years
Patient Education: Avoid eating raw or undercooked meat, educate about proper treatment of drinking water, discuss proper hygiene
glomerulonephritis, Hemolytic-uremic syndrome (HUS), Henoch Shonlein purpura (HSP)
hematuria/proteinuria w/recent URI, skin, GI infection, think_____
acute nephritic syndrome incl. postinfectious glomerulonephritis, IgA nephropathy, HSP, SLE, HUS
hematuria/proteinuria w/Edema, HTN, oliguria-think________
hematuria/proteinuria w/Rash or joint complaints-think_____
hematuria/proteinuria w/Frequency, dysuria, fever-think____
All require surgery, almost all are Indirect hernias
Treatment for inguinal hernia?
Candida usually includes the creases, while contact dermatitis does not.
How to determine clinically if rash is from candida or just contact dermatitis rash?
Often resolve spontaneously before puberty
Bland ointment (A and D) twice daily with gentle traction
Thin layer of topical estrogen cream bid for 2-3 weeks
How to treat vulvar adhesions?
Referall to urology at 10 months, surgery at 1 year if does not self-correct
When to refer for cryptorchidism?
What condition? Urethral opening present along ventral surface of penile shaft
10% of patients have cryptorchidism
Surgical repair recommended at 6-12 months
Communicating ( patent processus vaginalis)
Communicating or non-communicating hydrocele?
Gets larger throughout day, smaller in am
Noncommunicating ( processus vaginalis obliterated during development)
Communicating or non-communicating hydrocele
Small: resolve without intervention by 1 year
Large or tense: surgical correction
Acute twisting of a testicle
Pain/swelling of scrotum, absent cremasteric reflex