Urinary tract infection in children University of 儿童泌尿系感染.pptVIP

Urinary tract infection in children Professor Abdelaziz Elamin University of Khartoum Sudan Urinary tract infections (UTI) is common in the pediatric age group. Early recognition and prompt treatment of UTI are important to prevent progression of infection to pyelonephritis or urosepsis and to avoid late sequelae such as renal scarring or renal failure. Infants and young children with UTI may present with few specific symptoms. Older pediatric patients are more likely to have symptoms and findings attributable to an infection of the urinary tract. Differentiating cystitis from pyelonephritis in the pediatric patient is not always possible, although children who appear ill or who present with fever should be presumed to have pyelonephritis if they have evidence of UTI. Introduction UTI generally begins in the bladder due to ascending infection from perineal contaminants, usually bowel flora such as Escherichia coli. In neonates, infection of the urinary tract is assumed to be due to hematogenous rather than ascending infection. This etiology may explain the nonspecific symptoms associated with UTI in these patients. After the neonatal period, bacteremia is not the usual cause of UTI. The bladder is the initial primary locus of infection with ascending disease to the kidneys. Bacteremia may then appear as potential sequelae. Bacterial invasion of the bladder with overt UTI is more likely to occur if urinary stasis or low flow conditions exist. This is triggered by infrequent or incomplete voiding, reflux, or other urinary tract abnormalities. Pathophysiology Pathophysiology/2 Even in the absence of urinary tract abnormalities, cystitis may lead to vesicoureteral reflux, and it may worsen a pre-existing reflux. Untreated reflux causes pyelonephritis. Chronic or recurrent pyelonephritis results in renal damage and scarring that may progress to chronic renal failure. Prevalence varies based on age and sex Generalized bacteremia or sepsis may follow UTI. Approxim