儿科泌尿道感染(英文教学)Pediatrics Urinary Tract Infections资料汇总.pptVIP

Indications to order radiologic studies Children younger than 5 years of age with a febrile UTI Girls younger than 3 years of age with a first UTI Males of any age with a first UTI (PUV) Children with recurrent UTI Children with UTI who do not respond promptly to therapy Up To Date – accessed September 12, 2007 Studies to consider Renal Ultrasound Will evaluate for perinephric abscess in patients not responding to antibiotics. Can evaluate for hydronephrosis/hydroureter Of note, dilation of the kidneys and ureters can easily be seen on routine anatomy scans during pregnancy. Picking up vesicoureteral reflux while asymptomatic Does this help or hurt? Staging of VUR, antibiotics, etc... Hydronephrosis Male with the findings below.Cause? Studies to consider Voiding cystourethrogram – two techniques One involves fluoroscopic contrast – more radiation but better delineation of anatomy for grading VUR The other uses a radionuclide – less radiation and more sensitive than contrast Normal VCUG Vesicoureteral reflux (VUR) Megaureter Studies to consider Renal scintigraphy using dimercaptosuccinic acid (DMSA) Can detect scarring in the kidneys. Renal cells take up the tracer. Those cells damaged by pyelonephritis or scarring do not take up the tracer. Management or followup of patients does not change in most cases. Thus, not generally used for initial evaluation. Pediatric Urinary Tract Infections Eddie Needham, MD, FAAFP Program Director Emory Family Medicine Residency Program Objectives Define Urinary Tract Infection (UTI) List antibiotic treatment options for UTI List the workup after a first febrile UTI Be familiar with the rationale for using prophylactic antibiotics after the first febrile UTI Case 1 A four year old previously healthy girl presents to clinic with c/o dysuria. She has no fever and has a stable home with reliable parents. Immunizations are UTD. UA shows + Nitrites and + LE WBC – unknown because we don’t currently spin our own urines at Dunwood