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Published on: June 23, 2015
[Urinary tract infections in children]
E Lellig1, M Apfelbeck2, J Straub3
1Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. katja.lellig@med.uni-muenchen.de.
Insights
Prompt diagnosis and appropriate urine collection are crucial for pediatric urinary tract infections (UTIs) to prevent kidney scarring. Accurate diagnosis involves specific imaging techniques to detect vesicoureteral reflux.
Area of Science:
- Pediatric infectious diseases
- Pediatric nephrology
- Diagnostic imaging in pediatrics
Background:
- Urinary tract infections (UTIs) are highly prevalent bacterial infections in children.
- Nonspecific symptoms like abdominal pain, poor feeding, and incontinence can complicate early diagnosis.
- Effective diagnosis hinges on appropriate urine collection methods and timely treatment to prevent renal sequelae.
Purpose of the Study:
- To outline optimal urine collection techniques for diagnosing UTIs in children.
- To emphasize the importance of prompt empirical antibiotic therapy.
- To describe diagnostic approaches for vesicoureteral reflux (VUR) and renal scarring.
Main Methods:
- Urine collection methods vary by toilet training status: catheterization or suprapubic aspiration for non-toilet-trained, and clean-catch midstream for toilet-trained children.
- Empirical antibiotic therapy is initiated promptly upon suspected infection.
- Diagnostic workup for VUR includes voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy to assess for renal scarring.
Main Results:
- Proper urine collection is vital for accurate UTI diagnosis in children.
- Early antibiotic treatment is essential to mitigate the risk of kidney parenchymal scarring.
- The German standard approach involves VCUG for VUR diagnosis, with DMSA scintigraphy used to rule out renal scarring.
Conclusions:
- Accurate and timely diagnosis of pediatric UTIs requires appropriate urine sampling techniques.
- Prompt treatment is critical to prevent long-term kidney damage.
- A combined approach using VCUG and DMSA scintigraphy aids in the comprehensive evaluation of VUR and renal scarring in children.
Abstract:
Urinary tract infections (UTI) are the most common bacterial infections in children. The symptoms are not very specific and range from abdominal pain, poor feeding to nocturnal urinary incontinence. The technique of collecting urine plays an important role for securing the diagnosis. The best way to obtain urine in non-toilet-trained children is catheterization or suprapubic bladder aspiration. In toilet-trained children midstream urine is an acceptable alternative after cleaning the foreskin or labia. In the case of an infection a prompt empirical antibiotic therapy is necessary to reduce the risk of parenchymal scarring of the kidneys. There are different approaches to diagnose vesicoureteral reflux in different countries. The commonly used standard approach in Germany is voiding cystourethrography. In the case of reflux dimercaptosuccinic acid (DMSA) scintigraphy should be performed additionally to exclude renal scarring (bottom-up approach).
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