Urinary Tract Infections in Children Prof. Pushpa Raj Sharma

The Differences Difficult in collecting samples Symptoms are non specific Associated with congenital anomalies Risk of having serious complications Risk factors Permanent renal damage Poor long term prognosis

The Differences The risk of recurrence of UTI if infected before one year Of age is 18% in boys and 48% in girls.

Prevalence of UTI Sharma PR et al JIOM (1983);5: % of all childhood illness admitted in KCH Ball CS et al Paediatrics (1999):Vol11; Less than one year Girls:6.5%; Boys: 3.3% Kaushal RK et al Indian Pediatrics(2003) Vol 4 Girls: 8.4%; Boys: 6.1% Kanti Children’s Hospital Monthly data review, % of Urinary disease Hemsagar R : 2 months to 2 years with fever (2003) Female: 38.7% Male: 18.7%

Symptoms* –Fever80% –Failure to thrive12-15 % –Fainting6.1% –Fast breathing6.3% –Fowl smelling urine43-20% –Feeding problems83-17% –Frequency of urine34-12% –Frequent vomiting48-43% –Frequent constipation2% –Frequent diarrhoea8-18% *Rimal H and Sharma K (MD Thesis)

The Symptoms

Aetiologial Agents H.S. Rimal / K.R. Sharma

Antibiotic Sensitivity of the commonest etiological agent Antibiotics sensitivity E.coli Gentamycin62.5% Amikacin55% Cotrimoxazole60% Nalidixic acid35% Ciprofloxacin47.5% Rimal HS

Complications of UTI Acute Pyelonephritis Chronic pyelonephritis Renal scarring Hypertension Sepsis

Investigations for UTI Routine urine examination Culture Ultrasound DMSA scanning Micturating cystourethrogram CT/MRI

Treatment Acute attack: oral/IV antibiotics Repeated attacks: prophylactic Surgical treatment