UTI

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UTI
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• A two month-old infant stopped feeding and had
  a high intermittent fever. On examination she is
  febrile, other vital signs are normal. Chest
  clear and abdomen is soft. She was referred to
  the hospital, where she had an infection screen.

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Differential diagnosis

• UTI
• Septicemia
• Meningitis, Encephalitis
• URTI
• Tonsillitis, Otitis media

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First step

• Infection screen
• -FBC including differential WCC
• -Blood culture
• -Acute phase reactant e.g. CRP
• -urine for microscopy, culture and
  sensitivity.
• -CSF ( unless contraindicated) for
  microscopy, culture and sensitivity.
• -CXR

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• Our patient is
• two month old infant
• Female
• urine examination is the first investigation

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• Urine examination showed gt 100 WBC,
  gt100000E.coli/ml.
• SO OUR PATIENT HAS UTI.
• She was treated with intravenous antibiotics.

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• UTI could be due to
• 1-Infecting organisms
• 2-Incomplete bladder emptying
• infrequent voiding
• vulvitis
• hurried micturation
• obstruction by a loaded rectum from
  
  
  
  
  constipation
• Neuropathic bladder
• 3-Vesicureteric reflux.

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• Further investigation include
• -US with or without abdominal film.
• -DMSA scan
• -MCUG

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• Normal kidney in peadiatreics

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• An ultrasound showed a small right kidney with
  a dilated renal pelvis and a dilated ureter.
• She was started on prophylactic antibiotics.

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DMSA scan performed 3 month later.
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MCUG
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• At 5 years of age, the reflux had resolved and
  antibiotics prophylaxis was stopped. Her BP and
  renal growth and function continue to be
  monitored.

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Vesicoureteral Reflux

• Definition
• Vesicoureteral reflux (VUR) refers to a
  condition in which urine flows from the bladder,
  back up the ureter, and back into the kidneys.

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Vesicoureteral reflux causes damage to the
kidneys in two ways

• The kidney is not designed to withstand very much
  pressure. When VUR is present, backpressure of
  the urine on the kidney is significant. This can
  damage the kidney.
• The kidney is usually sterile, meaning that no
  bacteria are normally present within it. In VUR,
  bacteria that enter through the urinary tract may
  be carried back up the ureter with the urine.
  These bacteria can enter the kidney, causing
  severe infection.

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Grades of vesicoureteric reflux

• Grade I. VUR enters just the portion of the
  ureter closest to the bladder. The ureter appears
  normal in size.
• Grade II. VUR enters the entire ureter, and goes
  up into the collecting system of the kidney. The
  ureter and the collecting system appear normal in
  size and structure.
• Grade III. VUR enters the entire ureter and
  kidney collecting system. Either the ureter or
  the collecting systems are abnormal in size or
  shape.
• Grade IV. Similar to Grade III, but the ureter is
  greatly enlarged.
• Grade V. Similar to Grade IV, but the ureter is
  also abnormally twisted/curved, and the
  collecting system is greatly enlarged, with
  absence of the usual structural details

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The end