儿科泌尿道感染（英文PPT）Pediatrics Urinary Tract Infections.ppt

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. Scar in the superior and inferior pole of the right kidney Myths Bathing in bubble baths causes UTIs Wiping back-to-front causes UTIs Cranberry juice helps UTIs – only proven to be of minimal benefit in adult women. No proven benefit to children VUR Treatment 1997 AUA guidelines Children younger than 1 year of age, regardless of grade of reflux, should be treated medically, as they have a high likelihood of spontaneous resolution. Surgery is a reasonable option if they have grade V reflux and renal scarring. All patients with grade I or II reflux, either with unilateral or bilateral disease, should be tr