UTI & VUR UTI & VUR in childrenin childrenDr. Issa Hazza.MDDr. Issa Hazza.MDPediatric NephrologistPediatric NephrologistKHMCKHMCDefinitionDefinition

UTI is defined !" the presence of UTI is defined !" the presence of a p#re gro$th of %&''(''' a p#re gro$th of %&''(''' C)U*+lC)U*+lThe ris, of de-eloping s"+pto+atic UTI d#ring childhood is ./ for !o"s 0/for girls1/ of !o"s and &&/ of girls $ill ha-e UTI !" the age of &2 "ear3f all children $ith UTI half are +anifested d#ring the &st. 4ear of life567&6/ $ill ha-e scarring after their &st. UTI51.78'/of the+ $ill ha-e the scar at the ti+e of initial assess+ent56'/ of children $ith UTI $ill ha-e a f#rther infection $ithin the &st."ear and 86/ $ithin . "earsCo+plications of renal scarsCo+plications of renal scars5H"pertension5Poor renal gro$th5Rec#rrent ad#lt p"elonephritis5I+paired 9)R5:;R)Ris, factors for the de-elop+ent of Ris, factors for the de-elop+ent of scarringscarring5Urinar" tract +alfor+ation53!str#ction5Renal d"splasia5VUR5Therape#tic dela"54o#ng age PN is defined as>PN is defined as

)e-er %10 Positi-e ac#te phase reactants:;R(CRP(Ce#,oc"tosis ;ensiti-it"6170@/ ;pecificit"@@7B./ Positi-e #rine c#lt#reRenal scarring in children d#ring Renal scarring in children d#ring and after >PNand after >PN5D#ring >PN02/5>fter . +onths6B/5>fter . "ears 18/DM;> &p"elonephritisDM;> &p"elonephritis5Nor+al DM;> scan $ith >PN does not e?cl#de the ris, of ha-ing VUR5;carred ,idne"s $itho#t refl#? represent the +aDorit"5Renal scarring is associated +ore freE#entl" $ith gross refl#?5>!nor+al DM;> scan is higher in children PN co++on s"+pto+s d#ring infanc"infanc"5)e-er 5Poor feeding5)TT5Vo+iting (diarrhea5Irrita!ilit"5sepsis;igns and ;"+pto+s of Urinar" ;igns and ;"+pto+s of Urinar" Tract Infection in ChildrenTract Infection in Children5$rinary tract signs and symptoms D"s#ria )reE#enc" Dri!!ling*hesitanc" :n#resis after s#ccessf#l toilet training Malodoro#s #rine He+at#ria ;E#atting >!do+inal*s#prap#!ic pain5%ystemic signs and symptoms )e-er Vo+iting*diarrhea )lan,*!ac, painCriteria for the Diagnosis of UTICriteria for the Diagnosis of UTI Method of Collection FP#re C#lt#reG Pro!a!ilit" of Infection F/G5 ;P> 9ra+7negati-e !acilli an" n#+!er% BB/ 5 9ra+7positi-e cocci +ore than a fe$ tho#sand% BB/ 5 Trans#rethral catheterization%&'6 H B6/5Clean -oid =o"%&'@ Infection li,el" 9irlsThree;peci+ens &'6B6/T$o ;peci+ens &'6B'/3ne;peci+en&'60'/ I .''2 >+erican >cade+" of Pediatrics. ;ensiti-it" and ;pecificit" of Co+ponents of the Urinal"sis(;ensiti-it" and ;pecificit" of Co+ponents of the Urinal"sis( >lone and in Co+!ination >lone and in Co+!ination ;ensiti-it" / ;pecificit" /5Ce#,oc"te esterase 01 F287B@G 80 F2@7B.G5Nitrite 61 F&670.G B0 FB'7&''G 5 Ce#,oc"te esterase nitrite positi-e B1 FB'7&''G 8. F607B&G5 Microscop" J=Cs 81 F1.7&''G 0& F@67B0G=acteria 0& F&27BBG 01 F&&7&''G 5 Ce#,oc"te esterase ( nitrite+icroscop" positi-eBB.0 FBB7&''G 8' F2'7B.GI .''2 >+erican >cade+" of pediatrics;o+e >nti+icro!ials for ;o+e >nti+icro!ials for Proph"la?is of UTIProph"la?is of UTI

5 TMP alone or in co+!ination $ith ;MK . +g of TMP( &' +g of ;MK per ,g as single !edti+e dose or 6 +g of TMP( .6 +g of ;MK per ,g t$ice per 5 Nitrof#rantoin&7. +g*,g as single dail" dose5 Nalidi?ic acid 1' +g*,g di-ided e-er" &. h .VUR IN CHICDR:NVUR IN CHICDR:NTH: R:TR39R>D: P>;;>9: 3) TH: R:TR39R>D: P>;;>9: 3) URIN: )R3M: TH: =C>DD:R INT3 URIN: )R3M: TH: =C>DD:R INT3 TH: UR:T:R;TH: UR:T:R;..INC:D:NC:INC:D:NC:&/ IN IN)>NT&07@'/IN CHICDR:N :V>CU>T:D )3R TH:IR: &;T. UTI1'/ JICC H>V: R:N>C ;C>RRIN9

B1 CHICDR:N JITH PRIM>R4 VUR @8 M>C:*@2 ):M>C:59R3UP >1@ patients .6M(B).>NT:N>T>CC4 D?59R3UP = 6B patients..M(18)D? >)T:R UTIR:;UCT;R:;UCT;59R3UP >MICD VUR F&71G .6/;:V:R:F@76G86/ ;C>RRIN9 06/M%) 59R3UP =MICD8'/;:V:R:1'/;C>RRIN9 21/ )%M;igns and ;"+pto+s of Urinar" Tract Infection in Children 9R>DIN9 3) VUR9R>DIN9 3) VUR9 & R:)CUK IN UR:T:R 3NC49 .R:)CUK :KT:ND T3 R:N>C P:CVI;91 R:)CUK :KT:ND T3 R:N>C P:CVI; JITH DIC>T:D UR:T:R9@=CUNTIN9T 3) TH: C>C4C:;96UR:T:R>C T3RTU3I;IT4INTR3DUCTI3NINTR3DUCTI3NHODSON&EDWARD:DEMONSTRATED THE ASSOCIATION BETWEEN VUR AND RENAL SCARRING .1960 .CLIN.RADIOL.11:219-231BAILY : INTRODUCED THE TERM RN IN 193 TO IM!HASI"E THE RELATION BETWEEN RENAL DAMAGE ANDVUR.. 193.CLIN.NE!H.1:132-1#1DI>9N3;I; of VURDI>9N3;I; of VURWOR$U! %OR UTI>NT:N>T>C ;CR::NIN9INITI>C J3RKUP >T &INITI>C J3RKUP >T &st st DI>9N3;:D ):=. UTIDI>9N3;:D ):=. UTICHICD CUT: MCU9 &7.M3NTH DM;>.71 M3NTH CHICD %&4RU*; DM;> MCU9 I) R:N>C ;C>R >T >N4 >9: 3R )>MIC4 H? 3) VUR TH39:N:;I; 3) ;C>RRIN9P>TH39:N:;I; 3) ;C>RRIN9CHICDR:N =3RN JITH R:N>C ;C>RRIN9 DU: T3 D:V:C3PM:NT>C H4P3PC>;I>P3;TN>T>CC4 >CLUIR:D ;C>RRIN9 I; DU: T3 IN):CTI3NP>TH39:N:;I; of VURP>TH39:N:;I; of VUR>D P>TT:RN 3) INH:R:T>NC:MPR:V:C>NC: >M3N9 ;I=CIN9; 1./INTR>MUR>C C:N9TH3=CILU: :NTR4C3C>TI3N 3) TH: 3RI)IC:UR:THR>C 3=;TRUCTI3N

C3NTC3NTM.M.N:UR3MU;CUC>R DI;:>;:>=N3RM>C V3IDIN9 P>TT:RN.M>N>9:M:NT 3) VURM>N>9:M:NT 3) VUR5RNM&67.6/ 3) CHICDR:N JITH :;R) MMMUK5&'/ H4P:RT:N;I3N IN CHICDR:NM:DIC>C M>N>9:M:NTM:DIC>C M>N>9:M:NT5)3R VUR 9R>D: &71 >ND CHICDR:N 9: 3) >N4 9R>D:59R>D: @ JITH N3 ;C>RRIN9;UR9IC>C M>N>9:M:NT;UR9IC>C M>N>9:M:NT5N3N C3MPCI>NC:5R:CURR:NT UTI59R>D: @ JITH ;C>RRIN959R>D: 65UNR:;3CV:D VUR =4 >D3C:;C:NT;5T:)C3N INN:CTI3N H>; =::N >=>ND3N:D =:C>U;: 3) C3NC:RN: >=3UT :M=3CIO>TI3N 3) P>RTICC:;5C3CC>9:N N3T J:CC R:C3MM:ND:D =:C>U;: 3) HI9H R>T: 3) R:CURR:NC:;5IN)>NT >ND 43UN9 CHICDR:N ;H3UCD R:C:IV:D PR33H4C>KI; TICC TH: >9: 3) 672 4R >; C3N9 >; VUR I; PR:;:NT5CHICDR:N D? >)T:R TH: >9: 3) 64R 9IV:N PR3PH4C>KI; )3R &4R5)3R TH3;: JITH N:J ;C>R )3RM>TI3N PR3PH4C>KI; I; 9IV:N )3R C3N9:R P:RI3D3UTC3M:3UTC3M:59R>D: &7...06/ R:;3CV:D59R>D: 17@M.671'/ R:;3CV:D5;TUDI:; T3 C3MP>R: M:DIC>C >ND ;UR9IC>C M>N>9:M:NT )3R 9R>D: @76 )>IC:D T3 ;H3J >N4 ;T>TI;TIC>CDI)):R:NC: >ND C3NCCUD:D TH>T TH: D:9R:: 3) P>R:NCH4M>C R:DUCTI3N >ND )UNCTI3N>C IMP>IRM:NT >T TH: ;T>RT J:R: TH: M>IN )>CT3R; T3 D:T:RMIN: TH: 3UTC3M:DI>9N3;I;Mcontin#eDI>9N3;I;Mcontin#e....5ANTENATAL SCREENING5J3RKUP )3R UTI>ntenatal h"dronephrosis>ntenatal h"dronephrosis>!nor+alities detected antenatall" >!nor+alities detected antenatall"&.>!nor+alities in the size of the ,idne"s &.>!nor+alities in the size of the ,idne"s..>!nor+alities in the te?t#re of the ,idne"s ..>!nor+alities in the te?t#re of the ,idne"s1.The presence of -isi!le c"sts 1.The presence of -isi!le c"sts@.The presence of h"dronephrosis @.The presence of h"dronephrosisCa#ses of a!nor+all" large sized Ca#ses of a!nor+all" large sized ,idne"s,idne"s&. h"dronephrosis.. Pol"c"stic ,idne" disease1. M#ltic"stic d"splastic ,idne" @. Congenital nephrotic s"ndro+e6. Renal t#+o#r2. Co+pensator" h"pertroph"Conditions that can !e detected antenatall" Conditions that can !e detected antenatall"&. PUN o!str#ction.. VUN o!str#ction1. VUR@. =ladder o#tlet o!str#ction6. Mega#reter2. Do#ple? s"ste+8. Renal agenesis0. Renal d"splasiaB. >DPKD&'. >RPKD&&. Congenital N*;>ntenatal h"dronephrosis>ntenatal h"dronephrosisF>NHGF>NHGDefinitionrenal pel-is dia+eter %6++Mild 67B++Moderate&'7&6;e-ere %&6++ ;ociet" of )etal Urolog" 9rading ;"ste+ for ;ociet" of )etal Urolog" 9rading ;"ste+ for >ntenatall" Detected H"dronephrosis>ntenatall" Detected H"dronephrosis9rade Renal pel-is Parench"+al thic,nessI Mild splitting FdilatationG Nor+alII Moderate splittingco+ple? confined$ithin renal !order Nor+alIII Mar,ed splittingpel-is dilated o#tsiderenal !order cal"ces dilated Nor+alIV )#rther pel-ical"ceal dilatation ThinThe =ristol gro#p p#!lished prospecti-e The =ristol gro#p p#!lished prospecti-e datadata&0822 pregnant $o+en&'' F'.6B/Gcases $ith antenatal h"dronephrosis@2/ $ere !ilateral12/ had nor+al postnatal #ltraso#nd.0/ of antenatal h"dronephrosis $ill need s#rger"Postnatal in-estigationsPostnatal in-estigations>nti!iotic proph"la?is#sP&&2$,Nor+al h"dronephrosis;top a!.MCU9 repeat #sP&"r -#r no -#rDM;>M>91Indication for #rgent MCU9Indication for #rgent MCU9&. =ilateral h"dronephrosis Q distended !ladder.. Unilateral h"dronephrosisQ solitar" ,idne"C3NCCU;I3NC3NCCU;I3N5Children after a first UTI sho#ld !e in-estigated5infant $ith antenatal h"dronephrosis $arrant intensi-e in-estigation5The goal of treat+ent of UTI is pre-ention of renal inD#r" and s"+pto+s associated $ith UTI5;#rger" can c#res VUR ho$e-er Refl#? resol-es $ith ti+e