Health Tips

The purpose of this information is to give you a little insight into the topics most frequently asked by our parents. This information is designed to be used as a guideline. We encourage you to call our office, (617) 735-8585, when you have concerns regarding the care and well being of your child.

IDNEYS AND URINARY TRACT INFECTIONS

Of the many viral and bacterial infections your child may acquire during infancy and childhood, untreated or undiagnosed Urinary Tract Infections may have the most long-range consequences. Fever is the most common presenting complaint, often associated with lower abdominal pain. Of course, pre-verbal children (under age 2½) cannot tell you or your pediatrician or nurse practitioner about the pain. Therefore, one must always evaluate a persistent or recurring fever with no obvious findings on examination may as due to an underlying urinary tract infection.

The urinary tract has ureters, which are tubes that connect the kidneys and the bladder. Urine travels from the kidneys down the ureters into the bladder, which is essentially a storage container. From the bladder, a tube called the urethra exits at the end of the penis in boys or in the upper vaginal area in girls.

Infections may occur anywhere along the urinary tract system. Usually, the system is open from end to end and therefore even urine that may be infected will quickly flow out and cause no problem. However, if there is blockage anywhere in the system, then infected urine may not flow out of the body. Infected urine which does not flow out may lead to fever and symptoms. If such a blockage exists, it is important to find out where and how severe that blockage is. Any child under age five who is found to have a urinary tract infection needs to undergo evaluative studies to determine if there is a blockage or obstruction internally. A blockage can cause urine that has already flowed from the kidneys to the bladder to back up into the kidneys.

The diagnosis of urinary tract infection is first made by a laboratory test called a urine culture. Urine is collected either in a sterile bag or sterile cup or by a catheter inserted into the bladder. A urine culture is the only way to determine if the urine is infected. Many times, we collect more than one urine sample. Since any child with a urinary tract infection should undergo radiological evaluation to determine if a blockage exists and the extent of it, we want to be sure that that child's urine is truly infected.

The treatment for a urinary tract infection is antibiotic medication and almost all infections will respond rapidly. Children who are very ill with high fever and poor oral intake might need treatment by intravenous administration of antibiotics in the hospital but this is rare.

As stated earlier, all children with urinary tract infections need to have a diagnostic work-up to determine whether an obstruction exists and the extent of that obstruction, if any. This usual work-up involves two tests. One is a Renal Ultrasound, which is a non-invasive test to visualize the kidneys and bladder. The second is a VCUG in which a catheter is inserted through the urethra into the bladder and dye is infused to observe if urine is either backing up into the kidneys (called reflux) or the flow is blocked in any way.

If the work-up is negative, there is nothing to worry about. If the work-up is positive, then your child may need to take antibiotics for a year to see if he or she outgrows the blockage or reflux. Many children do outgrow the blockage or reflux as their kidneys, ureters and bladder grow in size. In some cases, surgery to correct the blockage or reflux is necessary.

In summary, a confirmed urinary tract infection is a red flag. We will want to evaluate your child's urinary tract to determine if a problem exists. In sixty-five percent of situations, a urinary tract infection is just a pot-luck occurrence but in thirty-five percent, an anatomical problem is diagnosed and those situations need careful follow-up.