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[Urinary tract infections in infants, an insidious clinical picture]
J A van Wijk1, A J van der Heijden
1Academisch Ziekenhuis Vrije Universiteit, afd. Kindergeneeskunde, Amsterdam.
Insights
Urinary tract infections in infants can present with vague symptoms like poor feeding and vomiting, leading to severe metabolic issues. Early recognition and treatment are crucial for recovery and preventing complications.
Area of Science:
- Pediatrics
- Nephrology
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) in young infants often present with non-specific symptoms, making diagnosis challenging.
- These infections can precipitate severe metabolic derangements, including pseudohypoaldosteronism, metabolic acidosis, and polyuria.
Observation:
- Three male infants presented with poor feeding, vomiting, and lethargy.
- Clinical presentation was attributed to urinary tract infections, confirmed by metabolic and ultrasonographic findings.
Findings:
- Metabolic disturbances observed included hyponatraemia, hyperkalaemia, and metabolic acidosis.
- Ultrasonography identified underlying anatomical anomalies in the urinary tract.
Implications:
- Prompt antibiotic therapy and surgical intervention for anatomical anomalies are essential for favorable outcomes.
- Persistent polyuria in one patient highlights the need for continued monitoring post-treatment.
- Increased clinical vigilance for UTIs in infants with non-specific symptoms is recommended, alongside comprehensive metabolic and urologic assessment.
Abstract:
Three boys aged 4, 5 and 7 weeks drank poorly, vomited and were lethargic. There were metabolic disorders attributable to a urinary tract infection. Ultrasonography revealed anatomical anomalies. After antibiotic treatment and, if necessary, surgical correction, the patients recovered. Follow-up was uncomplicated except persisting polyuria in one of the patients. A urinary tract infection in young children is difficult to recognise because of the aspecific presenting symptoms. It can cause a severe metabolic disturbance in which hyponatraemia and hyperkalaemia develop (pseudohypoaldosteronism), combined with metabolic acidosis and polyuria. A high alertness for urinary tract infections in young children with these aspecific symptoms is needed as well as metabolic and urologic evaluation.