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Urinary tract infection in childhood. Review of guidelines and recommendations
1Section of Pediatric Nephrology, Children's Mercy Hospital, University of Missouri at Kansas City School of Medicine, Kansas City, MO, USA.
Insights
Pediatric urinary tract infections (UTI) require prompt diagnosis and treatment. New imaging techniques aid in understanding kidney damage, guiding interventions for better outcomes in children with UTI.
Area of Science:
- Pediatric Nephrology
- Urology
- Infectious Diseases
Background:
- Urinary tract infections (UTI) are common in pediatric practice.
- Intrauterine damage from obstruction or vesicoureteral reflux (VUR) places kidneys at risk.
- Pediatricians play a crucial role in preventing ex-utero damage from bacterial infections.
Purpose of the Study:
- To review current guidelines and recommendations for diagnosing and treating pediatric UTI.
- To discuss the role of advanced uroradiologic imaging in understanding UTI etiology and outcomes.
- To outline management strategies for children with VUR.
Main Methods:
- Review of uroradiologic imaging techniques including cortical radionuclide scanning and prenatal ultrasonography.
- Discussion of diagnostic approaches such as cystography for VUR detection.
- Analysis of treatment modalities including antibiotic prophylaxis and surgical correction.
Main Results:
- Prenatal damage significantly impacts kidney risk in pediatric UTI patients.
- New oral antimicrobials reduce hospitalization rates for most children.
- Cystography is essential for investigating VUR in young children and select older children.
Conclusions:
- Early diagnosis and intervention are key to minimizing ex-utero damage in pediatric UTI.
- Long-term antibiotic prophylaxis is generally recommended for VUR, with surgery as an option for some.
- Investigation of siblings of children with VUR is recommended.
Abstract:
Children with urinary tract infection continue to be an important part of the pediatric practice. New uroradiologic imaging techniques like cortical radionuclide scanning and prenatal ultrasonography improved our understanding of the etiology, effect of treatment and outcome of these patients. Evidently, most kidneys at risk are those which already sustained intrauterine damage by obstruction or vesicoureteral reflux. It is the pediatrician's role to minimize ex-utero damage caused by bacterial infection by early diagnosis and appropriate intervention. The introduction of new potent oral antimicrobials limits the need for hospitalization only to the very young infant and the very seriously ill child. Whereas the roles of routine renal ultrasound and cortical radionuclide scan are debatable, all young children and select older children have to be investigated by cystography for possible vesicoureteral reflux. In children with vesicoureteral reflux, long-term antibiotic prophylaxis is required in most children but in a few surgical correction might be indicated. Young siblings of the propositus with vesicoureteral reflux have to be investigated as well for possible reflux. This review covers these and other guidelines and recommendations of diagnosis and treatment of UTI in children at the beginning of the third millennium.
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