Urinary infections in children

Abstract

Urinary tract infection (UTI) is a common infection in infants and children. During infancy, boys are more commonly affected than girls and thereafter, female preponderance is found. Presentation varies among different age groups. Clinical features in neonates and young infants are non-specific, manifest as septicemia where a high index of suspicion is needed. Older children typically present as simple or complicated UTI. Rapid diagnosis, institution of early treatment and further evaluation by imaging modalities are of utmost importance. The prevention of recurrent UTI and detection of congenital anomalies of kidney and urinary tract are major objectives in the management. Use of ultrasound is required to detect underlying congenital abnormalities, whereas voiding cystourethrogram and dimercaptosuccinic acid (DMSA) scan are useful in the diagnosis of obstructive uropathy and vesicoureteric reflux and renal scar, respectively. The children requiring surgical interventions are to be recognised early to prevent recurrent UTI. The treatment of vesicoureteric reflux by chemoprophylaxis in lower grades and surgical treatment in higher grades are important consideration in prevention of recurrent UTI. This is required to prevent renal parenchymal damage and scarring that can cause hypertension and progressive renal insufficiency in later life.