UTI in children 👶🏼
RF	·       Female ·       Uncircumcised male ·       VI-JR, anatomic defects ·       Dysfunctional voiding ·       Constipation
Clx	·       Dysuria ·       Fever ·       Suprapubic pain (cystitis) &/or flank/back pain (pyelonephritis)
Labs	·       Pyuria ·       Bacteriuria on urine culture
Tx	·       Antibiotic therapy (1-2 weeks w/ 3rd-gen cephalosporins) ·       If VCUG

VUR

• Dx? Voiding cystourethrography
• Tx:
• Nonsurgical vs surgical
• Primary –> may resolve on its own –> medical
• Secondary –> can be anatomical / functional
• Anatomical –> Surgery
• Functional –> tx underlying cause

Posterior urethral valves

• most common reason for a newborn boy not to urinate during the first day of life (meatal stenosis should also be looked for).
• Catheterization can be done to empty the bladder (the valves will not present an obstacle to the catheter).
•  Voiding cystourethrogram is the diagnostic test,
• Tx: and endoscopic fulguration or resection will get rid of them.

Obstructive uropathy

• def? obstruction of urinary tract, by any cause, that leads to back flow and hydronephrosis
• in peds, mcc is birth defects
• Dx:
• Palpable abdominal mass in newborn; most common cause is hydronephrosis
• Obtain VCUG in all cases of congenital hydronephrosis and in any with ureteral dilatation to rule out posterior urethral valves
• Causes
• MCC –> uretropelvic obstruction
• Important cause –> posterior urethral valve –> ⤴️ risk for ESRD
• Tx:
• Decompress bladder + IV Abx / vesicostomy

Nephrotic syn

• Steroid-sensitive MCDz is MC nephrotic syn in peds.
• Dx: UA –> proteinuria

Minimal Change Dz:

• Tx:  prednisone for 4–6 w, then taper 2–3 months w/o bx
• Restrict Na
• If severe: IV albumin + diuretics
• Bx? if HTN/hematuria/HF, or if steroid-resistant (u tx for 8 weeks, no response)
• Complications
• Infections –> check vaccinations! (pneumococcus, varicella, PPD)
• MC infection –> spontaneous peritonitis (s.pneumonia)
• Thromboembolism
• Prognosis: most have episodes of relapses, but they ⤵️ w/ age.

Torsion

• PEx? No cremastric reflex (torsion tears the relfex)
• Dx: Doppler flow U/S (only to determine direction of torsion and to guide manual detorsion, if urologist decides this is warranted; also to confirm successful detorsion in a completely asx px)
• Tx: emergent surgery

Epididymitis

• After puberty – sexual active
• Pain + scrotal swelling –> UA shows pyuria –> Tx w/ Abx