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Current Management of Urinary Tract Infection and Vesicoureteral Reflux

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Abstract

Urinary tract infection (UTI) is defined as the growth of a significant number of microorganisms of a single species in the urine, in the presence of symptoms. Symptoms in young children are non-specific such as fever without focus; young infants may manifest with irritability, failure to thrive, jaundice, vomiting and diarrhea. Older children usually have symptoms of cystitis or pyelonephritis. Symptoms of cystitis are dysuria, frequency, new onset incontinence and malodorous urine while symptoms of pyelonephritis are high grade fever, flank pain and vomiting. Rapid urine testing by microscopy for pus cells, dipstick testing for leukocyte esterase and nitrite, and enhanced urinalysis are supportive tests. Urine culture samples should be collected with proper technique and results interpreted for significant growth accordingly. Antibiotic therapy for 7–14 d for complicated UTI and 3–4 d for uncomplicated UTI is adequate. Further evaluation is recommended clinically for bladder-bowel dysfunction and obvious anatomical defects and by imaging for vesicoureteral reflux (VUR), usually by micturating cystourethrography (MCU). Since MCU involves exposure to radiation and urethral catheterization, it is now reserved for children with parenchymal involvement or recurrent UTI. VUR is the backward flow of urine into one or both ureters. Clinical manifestations other than UTI include incidental diagnosis on antenatal ultrasonography. Reflux nephropathy, the renal scarring associated with VUR may manifest clinically as hypertension, proteinuria and renal failure. The management of VUR is primarily with antibiotic prophylaxis. Anatomical correction is indicated in case of breakthrough febrile UTI. No intervention has been shown to reduce renal scarring.

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Authors and Affiliations

  1. Department of Pediatrics, INHS Asvini, Near RC Church, Colaba, Mumbai, India

    Ranjeet Wishram Thergaonkar

  2. Department of Pediatrics, All India Institiute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Pankaj Hari

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RWT performed a review of literature and prepared the first draft of the manuscript. PH critically reviewed the first draft. Both authors completed the final draft of the manuscript jointly. PH will act as guarantor for this paper.

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Correspondence to Pankaj Hari.

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Thergaonkar, R.W., Hari, P. Current Management of Urinary Tract Infection and Vesicoureteral Reflux. Indian J Pediatr 87, 625–632 (2020). https://doi.org/10.1007/s12098-019-03099-9

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