C3E1.2

So in terms of investigating and managing your retract infections,

this is the guideline that's really, really important.

And it's taken from nice.

So we said that to be able to get a urine sample,

you're going to do a clean catch urine sample

and then depending on the age range, decides what you do next.

So in an infant under three months.

And that's because we said if under three months

it's quite rare to get a urinary tract infection,

and usually about 50% are associated with structural anomalies as well.

So what we're going to do in that age groups,

we're going to send it off the culture because that helps to

identify what the bacteria was and how to best target antibiotic therapy.

We're going to refer to paediatrician,

and that's usually because we want to exclude sort of structural anomalies.

So they may be referred for imaging, which we'll talk about in a second,

but also because it can be a red flag for non accidental injury as well,

particularly sexual abuse.

So that's something that needs to be excluded,

and also you want to treat it.

And that's because usually infants are more likely to tip over inter sepsis,

so you want to make sure you manage it with antibiotics early

now in three months to three years.

Basically, what the urine analysis shows decides what you do next.

So if it's positive for leukocyte nitrites or both,

you're going to send it for culture to determine what the bacteria is,

and you're going to treat it with antibiotics.

Now we're less concerned in this age group. That's a structural anomaly.

So we're not going to frustrate paediatrics,

and you may or may not do imaging depending on the U.

T I, and we'll talk about that in the next slide.

Now is that over three years,

if it's positive for nitrates

or if it's positive for leukocyte and nitrites, you're going to treat

and also send it for culture.

Now, if it's only positive for leukocyte so leukocyte positive

nitrates negative,

then it's more non specific.

So we know that nitrites are more likely to indicate the U type,

whereas leukocyte could just be sort of that

you've got bacteria around the peri anal region.

You've got back to your ear, but not necessarily a urinary tract infection.

So what,

you're going to do if it's positive for just leukocyte suspended for culture,

but you wouldn't treat straight away,

and that's the same for adults as well. So that's something to be aware of

now.

Coming onto imaging imaging, as I said,

is something that we do a lot more in paediatrics because we're

concerned that structural anomaly such as the psycho you're a Terek reflux,

might be causing the U.

T. I.

So usually we you only attract ultrasound is the first line of imaging,

and you get that if it's the first time you t I in a six week year old child,

and that's because we said utilising this age group of rare.

But we also get an older Children if it's an atypical U. T I

and the criteria for an atypical U T. I is down here

or we said, if it's a recurring GT, so that's two episodes of Pailin arthritis,

one episode of Pailin, arthritis and cystitis, or three episodes of cystitis,

cystitis or within a year

now,

once you've done the ultrasound,

if you are concerned that a childhood recycle your a Terek reflux,

so we're gonna drop to the End column, you'd get them a mixture rating.

Yuri throw sista Graham or M C.

U G or a mag three scam Now, usually, if they're under six months,

you'd go for the M C u G.

And I was remember, because M. C U D s got you in it. I remember you for under six months

now is that over six months you go for the mag three.

Um, what this essentially looks for is a contrast scan, so the urine takes up.

So the contrast is excreted within the year and

so the year and will appear bright white.

And it will look for if there's any reflux of urine. So it's taken in real time.

And it's a series of X ray imaging looking at the contrast passing

through so you'll be able to see if there's any backwash of contrast.

Scanner of urine, which shows that there's reflux.

Now, if you're concerned that there is reflux,

or that there might be reflux and fr apathy that we'll talk about,

then there's a risk of renal paradigm or scarring.

So basically what happens is if you've got reflux and therefore apathy,

you get a reflux of urine back up into the urinary tract

now because as that reflux of urine back, you get increasing urinary Stasis,

and there's a high risk of beauties

Now. Infection will lead to inflammation

now inflammation in the kidney.

The kidney will try to heal itself by scouring,

so usually any inflammation in the body is healed by scarring.

Now the problem with scarring is that scar tissue doesn't

do the function that different states and their friends are responsible

for sort of filtering and the kidney for filtering products that

are out of your into that they can be excreted.

The scar tissue can't do that,

so that means that you get a risk of chronic kidney disease in Children.

But also scar tissue can't produce Renan,

if you remember the Renan and your tents and are just our own system,

um, in response to sort of blood pressure changes.

So obviously there's a risk of sort of hypertension as well

now, So you get a sort of Dems scan to look for renal scarring.

If it was a child who is under three who had a typical or recurrent UTI eyes

and, as I said,

the criterias below or if it's a child to

use over three years with recurrent beauty ice.

So that's just something to be aware of

now, in terms of managing, U T.

Is, what we're going to do is we refer to a paediatrician,

usually if it's under three months or older than three months with Palin arthritis.

And that's because usually most Children with polio

nephritis are admitted for I V antibiotics.

Or we're going to just give antibiotics

and usually the pilot arthritis.

Ivica Moxie Club set flex and acid reflux is in can be used interchangeably.

This cystitis, usually night if you're in tone or try method,

print my preferred with nitro if you're in tone,

typically being one of the first line over try method print.

No, just talking a little bit about reflux. Never apathy.

So what I mentioned is that this is usually occurs secondary to the psyche.

You're a Terek reflux.

So where there's a problem with the vows that prevent

the backflow of urine between the ureter and the bladder.

Now it can occur if there is a posterior urethral valve,

which is an anatomical abnormality

but typically can lead to obstruction.

It can also curve.

There's a tur in the urinary tract or if there's a Euro genic bladder.

So what happens is,

instead of urine gently passing down from sort of the ureter into the bladder,

you get this reflux back from the bladder up into the ureter.

Now this reflux, as I said Lee, can lead to recurrent UTI is due to urinary Stasis

and also due to just passing that you're in back up

now. You're currently duties needs to sort of inflammation.

Inflammation needs to scarring

because scar tissue doesn't do the function of the

kidney that we'd expect it can lead to hypertension,

and it can lead to chronic kidney disease as well.

So to look for the actual reflux,

we said that we use an M C U G if they're under six months or we use mag three.

If they're over that

and then to look for renal scarring, we use a D m. Mr Scan as you go to

C3E1.2

Chapters

Audio TranscriptAuto-generated