UTI in children + LONG CASE

Urine samples

• Urine samples need to be collected for urine tests. Urine tests may be done for a number of reasons, and they are the only way to know for sure if your child has a urinary tract infection (UTI).
If the reason for the urine test is to determine if your child has a UTI, it is very important that the urine is obtained from your child in a sterile (clean) way so that the sample is not contaminated with bacteria (germs) from the skin.
Your doctor will tell you which method is most appropriate, and will provide you with any equipment you need to collect a sample.

Collecting a urine sample from younger children

Babies and small children can't wee ‘on demand’, which makes it difficult to get a sample. There are four possible ways to get urine from younger children.

Clean-catch

This method involves trying to catch some urine in a sample container that your doctor will give you. Start by offering your child a drink (cup, bottle, breastfeed). Most children who are going to wee for a clean-catch will do so within one hour.
• Have the sample container ready.
• Remove your child’s nappy.
• Wash your hands thoroughly before collecting the sample, or wear gloves.
• Clean the skin around the genital area. Use clean plastic tweezers and gauze soaked in water if available, or use baby wipes (Figure 1).
• Keep watching until your child does a wee. Be ready to catch a urine sample in the container when the wee comes.
• To encourage your child to wee, you can gently rub their lower abdomen (tummy) for a few minutes using a clean piece of gauze soaked in cold water (Figure 2).
• Hold the container away from your child’s skin when catching the urine (Figure 3). This is important so that bacteria from your child’s skin (or your skin) don’t contaminate the urine sample.



Bag specimen

Your doctor might give you a special bag to catch the wee in. This bag is stuck to the skin using gentle double-sided tape. In general, this method should not be used when testing for UTIs, as germs from the skin often contaminate the bag and urine.

Catheter

A catheter is a tube that a nurse or doctor puts into your child’s bladder through their urethra (the hole where the urine comes out). Fewer germs from the skin get into the sample this way compared with the clean-catch method. A catheter is a good way to collect a urine sample when there is not much urine in the bladder. However, your child may find the catheter uncomfortable, and they may be distressed at being held still while it is being inserted.

Suprapubic aspirate (SPA)

For an SPA, your child will need to lie on their back and be held still. A doctor puts a needle through the skin of the lower abdomen into your child’s bladder and takes out some urine. Germs from the skin can't get into the urine, so SPA is the cleanest way to collect a sample.
An SPA is very safe, and problems are rare. SPAs are usually very quick, but because they involve using a needle, they can hurt and so they are only done in certain circumstances.
If your baby or child's bladder is not full, the doctor may not be able to get any urine with an SPA. In this case, the doctor may wait a little while and try again, or use the catheter method instead.

Collecting a urine sample from older children

You can collect a midstream specimen from older children who can wee when asked to. You doctor will provide you with a sample container.
• Clean the skin around the genital area, using gauze if available, otherwise with baby wipes, damp tissues or a clean, wet facewasher.
• When your child starts to wee, let some wee pass into the toilet.
• Collect a sample from halfway through the wee (midstream).
• Don’t let the sample container touch the skin.

Key points to remember

• If a urine test is for UTI, it is important that a urine sample is obtained in a sterile way.
• Clean-catch, catheters or suprapubic aspirates are suitable ways to collect urine samples from babies and small children for UTI tests.
• Midstream specimens can be collected from older children who can wee on demand.
 



urine dipsticks in private practice but in hospital setting urine analysis and urine full report. urine analysis with clinical features is only suggestive
 



 



SPA = suprapubic aspiration straight from bladder under sterile condition
 



according to the ABST also
 



unable to take orally in vomitting etc
we do not use nitrofurantoin and nalidixic acid not used in upper UTI
 



 



 



 



 



for doses see guidelines



 
 



sme kids don't void coz don't want to go to school toilet
VUR until 5 years antibiotic prophylaxis
formulary for renal dose if renal impairment (obly for CKD and not for simple scar)
 



specilaist referral to paediatric nephrologist
 



 



 



 



static scan so not excretory fucntion
4-6 months after first UTI so prophylaxis antibiotics necessar





 



scarring of left kidney - from the back
 



 



 



 



minimum of 3 xrays so high radiation dose
 



posterior urethral valve? or if US shows high degree of reflux with obstruction ......indications
 



 



 



 



3 - dilatation
4 - marked dilatation and torturation
5 - marked both - VUR or even posterior urethral valve (secondary reflux)
current only high grade (4-5) need antibiotic prophylaxis. ultrasound can find out
 





 



 
 



 



 



UTI ...poor stream with palpabale bladder hihgly suggestive for a boy
 



fruit of cashew nut - lateral MCUG -
 



30 films upto 30 mins dynamic so not just uptake but excretion also. this is from the back...some problem in excretion of left kidney flow....commonest obstruction at the level is PUJ obstruction
DTPA done if suspect any obstruction
DTPA renogram -



Important topic - in clinicals
EXTRA STUFF
https://embryology.med.unsw.edu.au/embryology/index.php/Renal_System_-_Abnormalities

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