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Evaluation of urinary tract infection in malnourished black children
1Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Urinary tract infections (UTIs) are common in malnourished children. Imaging beyond renal sonography is not typically needed for a first UTI episode in these patients if renal function is normal.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infection (UTI) is a recognized complication in malnourished children.
- The necessity of investigating these patients for underlying renal pathology requires further definition.
Purpose of the Study:
- To evaluate the prevalence of UTI in malnourished children.
- To determine the necessity of renal imaging in malnourished children with UTI.
Main Methods:
- Seventy-five malnourished children were assessed for UTI via suprapubic urine culture.
- Infected patients underwent renal ultrasonography, intravenous pyelography (IVP), and voiding cystourethrography (VCU).
- Hematological and biochemical parameters were analyzed.
Main Results:
- UTI was diagnosed in 34.7% of children, predominantly boys (81%).
- Prevalence was 42% in kwashiorkor/marasmic kwashiorkor cases, with Escherichia coli being the most common pathogen (84.6%).
- All infected children had normal renal sonography, IVP, and VCU findings; no vesicoureteric reflux was detected.
Conclusions:
- This study confirms a high prevalence of UTI in malnourished children.
- No anatomical abnormalities were found in infected patients, suggesting advanced renal imaging is not indicated for a first UTI episode in malnourished children with normal renal function.
Abstract:
Urinary tract infection (UTI) is a well recognized complication in malnourished children. The need to investigate these patients for underlying renal pathology has not been clearly defined. Seventy-five children with malnutrition were evaluated for UTI by culture of urine obtained suprapubically prior to antibiotic therapy. All patients with UTI were investigated with renal ultrasonography, intravenous pyelography (IVP) and voiding cystourethrography (VCU). Haemoglobin, white cell count, serum urea, creatinine and electrolytes were determined in all the children. The mean age of the children was 15.5 months (range 3-60 months). UTI was diagnosed in 26 (34.7%), of whom 21 (81%) were boys. The overall prevalence of UTI in those with kwashiorkor/marasmic kwashiorkor was 42%. Escherichia coli was the organism most commonly cultured (84.6%). Renal sonography, IVP and VCU were normal in all infected cases and vesicoureteric reflux was not detected in any. This study confirms the high prevalence of UTI in malnourished children. As no anatomical abnormalities were demonstrated in the patients with UTI, imaging of the renal tract other than real sonography does not appear to be indicated in the malnourished child in a first episode of UTI with normal renal function.