Beruflich Dokumente
Kultur Dokumente
in children
Dr. Issa Hazza.MD
Pediatric Nephrologist
KHMC
:Definition
UTI is defined by the presence of
a pure growth of >100,000
CFU/ml
Hypertension
Poor renal growth
Recurrent adult pyelonephritis
Impaired GFR
ESRF
Causes of CRF
UK
NAPRICS
16.1
5.4
15.8
13.3
22
6.8
Diagnosis
Congenital abnormalities
Reflux nephropathy
Neurogenic bladder
NB without neurological deficit
NB with spinal dysraphism
Obstructive uropathy
Renal dysplasia
Hereditary conditions
Oxalosis
ARPKD
Nephronephthesis
Cystinosis
Other
Glomerulopathy
Mesangio capillary GN
Henoch-Schonlein purpura
Focal segmental glomerulosclerosis
Crescentic GN
Diffuse mesangial nephritis
Post strept GN
Number
Percent
80
68.4
36
21
14
7
12
11
30.8
17.9
11.9
6
10.3
9.4
16
13.7
8
3
3
1
1
6.8
2.6
2.6
0.9
0.9
15
12.8
6
3
2
2
1
1
5.1
2.6
1.7
1.7
0.9
0.9
5
1
117
4.3
0.9
100
:APN is defined as
Fever >38
Positive acute phase reactants
ESR,CRP,Leukocytosis
Sensitivity 53-84%
Specificity 44-92%
Positive urine culture
86%
59%
37%
DMSA &pyelonephritis
Normal DMSA scan with APN does not
exclude the risk of having VUR
Scarred kidneys without reflux represent
the majority
Renal scarring is associated more
frequently with gross reflux
Abnormal DMSA scan is higher in children
<1 year
Fever
Poor feeding
FTT
Vomiting ,diarrhea
Irritability
sepsis
Girls:
Three
Specimens
Specimens
105
90%
One Specimen
105
105
80%
95%
> 99%
Infection likely
Two
Leukocyte esterase
Nitrite
Leukocyte esterase
nitrite positive
Microscopy:
WBCs
Bacteria
Leukocyte esterase , nitrite
microscopy positive
Sensitivity %
83 (67-94)
53 (15-82)
Specificity %
78 (64-92)
98 (90-100)
93 (90-100)
72 (58-91)
73 (32-100)
81 (16-99)
81 (45-98)
83 (11-100)
99.8 (99-100)
70 (60-92)
VUR IN CHILDREN
THE RETROGRADE PASSAGE OF
URINE FROME THE BLADDER INTO
.THE URETERS
INCEDENCE
IN INFANT 1%
18-40%IN CHILDREN EVALUATED FOR
THEIRE 1ST. UTI
WILL HAVE RENAL SCARRING 30%
RESULTS
GROUP A:MILD VUR (1-3) 25%
SEVERE (4-5) 75%
SCARRING
85%
M>F
GROUP B:
MILD
SEVERE
SCARRING
F>M
70%
30%
63%
GRADING OF VUR
G 1 :REFLUX IN URETER ONLY
G 2:REFLUX EXTEND TO RENAL PELVIS
G3: REFLUX EXTEND TO RENAL PELVIS
WITH DILATED URETER
G4:BLUNTINGT OF THE CALYCES
G5:URETERAL TORTUOISITY
INTRODUCTION
HODSON&EDWARD:DEMONSTRATED
THE ASSOCIATION BETWEEN VUR AND
RENAL SCARRING .1960 .CLIN.RADIOL.11:219-231
DIAGNOSIS of VUR
PATHOGENESIS OF SCARRING
CHILDREN BORN WITH RENAL
SCARRING DUE TO DEVELOPMENTAL
HYPOPLASIA
POSTNATALLY ACQUIRED SCARRING IS
DUE TO INFECTION
PATHOGENESIS of VUR
AD PATTERN OF INHERETANCE
PREVELANCE AMONG SIBLINGS 32%
INTRAMURAL LENGTH
OBLIQUE ENTRY
LOCATION OF THE ORIFICE
URETHRAL OBSTRUCTION
.CONT
NEUROMUSCULAR DISEASE
ABNORMAL VOIDING PATTERN.
MANAGEMENT OF VUR
RN15-25% OF CHILDREN WITH ESRF
UK
10% HYPERTENSION IN
CHILDREN
MEDICAL MANAGEMENT
FOR VUR GRADE 1-3 AND CHILDREN
<1YR OF AGE OF ANY GRADE
GRADE 4 WITH NO SCARRING
SURGICAL MANAGEMENT
NON COMPLIANCE
RECURRENT UTI
GRADE 4 WITH SCARRING
GRADE 5
UNRESOLVED VUR BY ADOLESCENTS
OUTCOME
GRADE 1-2:..85% RESOLVED
GRADE 3-425-30% RESOLVED
..DIAGNOSIScontinue
ANTENATAL SCREENING
WORKUP FOR UTI
Antenatal hydronephrosis
hydronephrosis
Polycystic kidney disease
Multicystic dysplastic kidney
Congenital nephrotic syndrome
Renal tumour
Compensatory hypertrophy
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
PUJ obstruction
VUJ obstruction
VUR
Bladder outlet obstruction
Megaureter
Douplex system
Renal agenesis
Renal dysplasia
ADPKD
ARPKD
Congenital N/S
Antenatal hydronephrosis
(ANH)
Definition:
renal pelvis diameter >5mm
Mild
5-9mm
Moderate 10-15
Severe
>15mm
III
IV
Renal pelvis
Parenchymal thickness
Mild splitting (dilatation)
Normal
Moderate splitting
complex confined
within renal border
Normal
Marked splitting
pelvis dilated outside
renal border
calyces dilated
Normal
Further pelvicalyceal dilatation Thin
Postnatal investigations
Antibiotic prophylaxis
us@1&6wk
Normal
hydronephrosis
Stop ab.
MCUG
repeat us@1yr
vur no vur
DMSA MAG3
CONCLUSION
Children after a first UTI should be
investigated
infant with antenatal hydronephrosis
warrant intensive investigation
The goal of treatment of UTI is prevention
of renal injury and symptoms associated
with UTI
Surgery can cures VUR however Reflux
resolves with time