Urinary ract infection in children, renal system, urinary system, pediatrics

1. RENAL SYSTEM
URINARY TRACT INFECTIONS

2. It is the most common
conditions of childhood. It
may involve urethra,
bladder, calyces and renal
parenchyma.
It mainly includes:
 Upper: it involves the ureters
and
kidneys(Pyelonephritis)
 Lower: it involves the
urethra(Urethritis) and

3. INCIDENCE
 3-8% of girls and 1-2% of boys
develop a UTI during childhood.
 Peak incidence is between 2 – 6
years of age.

4. CLASSIFICATION
 Bacteriuria
 Asymptomatic bacteriuria
 Symptomatic bacteriuria
 Recurrent UTI
 Persistent UTI
 Febrile UTI
 Urethritis
 Cystitis
 Pyelonephritis
 Urosepsis

5. ETIOLOGY
 Escherichia coli – 80% of cases
 Gram negative enteric organisms
 Other organisms include Proteus, pseudomonas,
klebsiella, staphylococcus aureus, haemophilus
etc.
 Anatomic and physical factors
 Structure of lower urinary tract accounts to
bacteriuria in females
- Short urethra in young girls (2cm) & in mature
women (4cm) provides pathway for organism to
invade

6.  Closure of urethra in the end of micturition may
lead to return of bacteria to bladder
- Longer male urethra and prostatic secretions
inhibit entry of pathogens in males
 Urinary stasis
 Incomplete emptying result from reflux ,
anatomic abnormalities, dysfunction of voiding
mechanism, extrinsic ureteral compression
caused by constipation etc leads to UTI.
 Altered urine and bladder chemistry
 An alkaline medium is favored by the pathogens.
A urine pH of about 5 hampers the bacterial
multiplication.

7. RISK CATEGORY
 Throughout childhood, the risk of having a UTI is 2
percent for boys and 8 percent for girls.
 Having an anomaly of the urinary tract increases the
risk of a UTI.
 Vesicoureteral reflux
 Urinary obstruction
 Dysfunctional voiding
 Boys who are younger than 6 months sold who are
not circumcised are at greater risk for a UTI than
circumcised boys the same age.

8. PATHOPHYSIOLOGY
Cause : UVR, catheterization , postponement of
voiding, DM, low fliud intake etc
bacteria ascends the urethra
Lining of urinary tract becomes inflammed
Micturition reflex triggered
Urgency, frequency, burning hematuria, irritability,
failure to thrive, pyuria

9. DIAGNOSTIC EVALUATION
 Urine culture
 First morning urine specimen
 Clean catch mid stream
 specimen
 Collection bag
 Supra pubic aspiration
 Bladder catheterization
 Urinalysis
 Increased number of RBC
 Nitrate test positive
 Significant bacteriuria
 Renal ultrasound
 GU tract anatomy
 Pelvi calceal dilatation
 Hydronephrosis
 Renal scarring
 Dipstick tests
 USG
 VCUG
 GU anatomy
 IVP

10. THERAPEUTIC MANAGEMENT
 Goals
-eliminate current infection
-Identify contributing factors and reduce risk of occurrence
-prevent systemic spread of infection
-preserve renal function
 Antibiotic therapy based on:
 identification of pathogen
 history of antibiotic use
 location of infection
 Antimicrobial drugs (sometimes it will not be effective
due to resistance of organism)
 Anti-infective agents
 penicillin, sulfonamide, cephalosporin, nitrofurantoin

11.  SURGICAL MANAGEMENT
For primary reflux or bladder neck obstruction,
surgical correction is needed to avoid recurrence.
 NURSING MANAGEMENT
 Careful history taking regarding voiding habits, stooling
pattern
 Caution the parents in suspected cases
 Collect appropriate specimen
 Checking diaper half hourly for straining, dripping of small
amounts of urine.
 Explanation of procedure according to their age
 Administer proper dosage of medications
 Increase the fluid intake

12. COMPLICATIONS
Most UTIs are not serious, but some infections can
lead to serious problems, such as kidney infections.
Chronic kidney infections
Infections that recur or last a long time can cause
permanent damage, including kidney scars, poor
kidney growth, poor kidney function, high blood
pressure, and other problems.
Some acute kidney infections
infections that develop suddenly can be life
threatening, especially if the bacteria enter the
bloodstream, a condition called septicemia.

13. PREVENTION
 Simple hygienic habits should be followed
 Practice habit of voiding soon as they feel the urge
 Adolescent girls are advised to urinate soon after an
intercourse
 Reinforce parents and older children the importance
of compliance
 Circumcision in males
 Plenty of oral fluids
 Treatment of constipation, pinworms