Urinary tract infection in childrenProfessor Abdelaziz ElaminUniversity of KhartoumSudanUrinarytractinfections(UTI)iscommoninthepediatric agegroup.Earlyrecognitionandprompttreatmentof UTIareimportanttopreventprogressionofinfectionto pyelonephritisorurosepsisandtoavoidlatesequelae such as renal scarring or renal failure. InfantsandyoungchildrenwithUTImaypresentwith few specific symptoms. Older pediatric patients are more lielytohavesymptomsandfindingsattri!uta!letoan infectionoftheurinarytract."ifferentiatingcystitisfrom pyelonephritisinthepediatricpatientisnotalways possi!le# although children who appear ill or who present withfevershould!epresumedtohavepyelonephritisif they have evidence of UTI. IntroductionUTIgenerallybeginsinthebladderduetoascending infection from perineal contaminants, usually bowel fora suchasEscherichiacoli.Inneonates,infectionofthe urinarytractisassumedtobeduetohematogenous ratherthanascendinginfection.Thisetiologymay explain the nonspecifc symptoms associated with UTI in these patients. ftertheneonatalperiod,bacteremiaisnottheusual causeofUTI.Thebladderistheinitialprimarylocusof infectionwithascendingdiseasetothe!idneys. "acteremiamaythenappearaspotentialse#uelae. "acterialin$asionofthebladderwitho$ertUTIismore li!elytooccurifurinarystasisorlowfowconditions exist.Thisistriggeredbyinfre#uentorincomplete $oiding, refux, or other urinary tract abnormalities. PathophysiologyPathophysiology/2E$enintheabsenceofurinarytract abnormalities,cystitismayleadto $esicoureteral refux, and it may worsen a pre%existingrefux.Untreatedrefuxcauses pyelonephritis.&hronicorrecurrent pyelonephritisresultsinrenaldamageand scarringthatmayprogresstochronicrenal failure. $revalence varies !ased on age and se%&enerali'ed!acteremiaorsepsismayfollow UTI.(ppro%imately)*+of,-to)-month-old infants with UTI are at ris of developing sepsis. Therisdropstoappro%imately.+inpatients older than ) months.Ifleftuntreated#simplecystitismayprogressto pyelonephritis./oreseverecaseshavethe potentialforidneydamage#whichmayleadto hypertension or renal insufficiency.(ppro%imately.-,*+ofchildrenwith symptomaticUTIandfeverdeveloprenal scarring.linical ourseUTI is more frequent in females than males at all ages with the e%ception of the neonatal period# during which UTI may !e the cause of an overwhelming septic syndrome in male infants younger than 0 months.Uncircumcised males have a higher incidence than circumcised males. Uncircumcised male infants have a higher incidence of UTI than female infants.!re"uency of U#IE%cluding neonates# females younger than ,, years have a )-.+ ris1 !oys of the same age have a ,+ ris.UTI is the source of infection in up to 2-3+ of fe!rile infants in the first ) months of life.!re"uency of U#I/2$% &acterial virulencei%e% antigen K and presence of fimbriae2% 'ost factors (Anatomical )U* +,- of children.ith U#I /abnormal insertion of ureters inthe bladder% Urinary tract obstruction caused by phimosis0 meatal stenosis posterior urethral valves0 diverticuli0 and ureteric stricture or 1in10 andcalculi%Ind.elling catheter!unctional ( such as neurogenic bladder in spina bifida patients0 andinappropriate detrusormuscle contractions Immunologic 2 in immune deficiency *is1 !actorsSymptoms4istory5 vary with the age of the patient. 4istory is dependent uponthe caregiver in younger children. 6ymptoms in 7eonates5 8aundice4ypothermia or fever9ailure to thrive$oor feeding:omiting6ymptoms in Infants5 $oor feeding9ever:omiting# diarrhea6trong-smelling urineSymptoms/2$reschoolers :omiting# diarrhea# a!dominal pain9ever6trong-smelling urine# enuresis# dysuria# urgency# frequency6chool-aged children 9ever:omiting# a!dominal pain6trong-smelling urine# frequency# urgency# dysuria# flan pain# or new enuresis(dolescents are more liely to have some of the classic adultsymptoms. (dolescent girls are more liely to have vaginitis ().+) than UTI (,;+). Those diagnosed with cystitis frequently have a concurrent vaginitis. 4ypertension should raise suspicion of hydronephrosis or renal parenchyma disease.