Sandbox:Rana

Urinary tract infections (UTIs) are common in kids. it occurs when bacteria (germs) get into the bladder or kidneys.Up to 8% of girls and 2% of boys will get a UTI by age 5.

Sometimes the symptoms of this infection can be hard to spot in kids,that is why Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition.PMID: 30592257

A baby with a UTI may have a fever, throw up, or be fussy. Older kids may have a fever, have pain when peeing, need to pee a lot, or have lower belly pain

causesPMID: 20514772

10.1586/14787210.2015.986097 dio

• fire: UTI in children is of concern because it can be associated with acute mortality (i.e. urosepsis) and/or chronic medical problems like renal scarring, hypertension, and chronic renal insufficiency [7].PMID: 25421102

In the age of “ALARA” (as low as reasonably achievable), physicians must judiciously utilize imaging to decrease the adverse events associated with radiation exposure. In 1999, the AAP recommendations for imaging after an initial febrile UTI were extensive and included renal and bladder ultrasound, voiding cystourethrography (VCUG) or radionuclide cystography in all children younger than two years of age [43]. This approach became widely known as the “bottom-up” algorithm because it begins with the diagnosis of VUR. In these guidelines, the AAP was vague concerning the use of 99mTc-DMSA. However, the American Academy of Family Physicians advised this test after treatment of UTI to determine if permanent renal scarring occurred. This approach exposed children to many invasive radiologic examinations [44]. Since 1999, a vast amount of research has been done to demonstrate that the amount of imaging performed in these children can be safely reduced, and that the children most at risk for renal scarring can still be identified.

In the latest AAP UTI guidelines, VCUG is no longer recommended after the initial UTI. However, renal and bladder ultrasound is still recommended. Ultrasound is non-invasive and poses no radiation risk to the child. Moreover, a renal ultrasound is useful to screen for renal abnormalities like as hydronephrosis. If the child does have hydronephrosis, the underlying cause may need to be determined by utilizing further imaging modalities such as VCUG or MAG-3 renal imaging [42]. The AAP modified its stance on VCUG imaging after first febrile UTI because only a small number of children ultimately require surgical or medical treatment for VUR. Delaying a VCUG until UTI recurrence avoids VCUG in approximately 90% of children with a first febrile UTI. Thus, if a VCUG is performed, the likelihood that a child has high-grade VUR is greater as children at highest risk of febrile UTI recurrence are those with clinically significant VUR.

The NICE guidelines also recommend that all children younger than 6 months undergo an ultrasound within 6 weeks of the infection. However, the NICE guidelines differ in that ultrasonography is not recommend in children older than 6 months with an uncomplicated febrile UTI [42]. To add to the confusing aspect of UTI imaging, subsequent studies have both disputed and upheld these guidelines. For example, Ristola and Hurme conducted a retrospective review of a cohort of 672 patients younger than 3 years of age with UTI. According to their data, if the NICE guidelines had been applied to their cohort, 59 patients with VUR would have been missed and 13 of these eventually underwent surgical anti-reflux surgery [45]. In contrast, Deader et al demonstrated that the vast majority of renal anomalies demonstrated on what they deemed “inappropriate” ultrasounds were of little significance, thereby concluding the NICE imaging guidelines are safe and appropriate [46].

uti

UTI

Urine analysis
first time				recurrent eoisodes
<2 years	>2years old			Ultrasound
Ultrasound	treatment with antimicrobials according to local sensitivity patterns			Dimercaptosuccinic acid (DMSA) scan
*if US normal tratment with antimicrobial *if Us abnormal give Ab +further managment with specialst

prophylaxis and prevention

Antibiotic prophylaxis has modest benefits, increases antibiotic resistance, and is not indicated after first or second UTI in otherwise healthy children. For children with VUR, antibiotic prophylaxis reduces UTI recurrence but does not reduce scarring.

Simple hygiene such as wiping front to back in females can avoid introducing bacteria into the urethral orifice

Active management of toilet training and constipation is important to prevent functional bladder–bowel dysfunction

Circumcision reduces the risk of UTI in males