UTI in children

Urinary tract infection
?1-3% of girls and 1% in boys
?-peak via infancy and toilet training, after the 1st attack of girls, 60-80% will develop 2nd attack of UTI, within 18 months
?-in boys, more common in 1st year and much more common in uncircumcised,
?-in 1st year M/F 2.4-5.4:1, beyond infancy , the ratio is 1:10
?
?Atiology
?Mainly by colonic bacteria, in female, 75-90% due to E-coli followed by proteus and Kliebsiella .In male, older than 4 year , proteus common as E-coli, reported G+ve in male
?Staph-saprophyticus is a pathogen in both sex
?Virus(adeno) 11,21 cystitis
?UTI have been consider as imported cause in development of renal insufficiency and end stage renal disease
pathogensis
Nearly all UTI are secondary from bacteria arise from fecal flora , colonized the perineum and enter the bladder via urethra, or from bacteria beneath the prepuse in uncircumcised boy , it may lead to pyelonephritis.
Rarly hematogeneusa
Risk Factors of UTI
Female, uncircumcised boy, vesicouretric reflux(VUR), toilet training, obstructive uropathy, urethral insterumentation, wiping from back to front, bubble bathing, tight clothes, pin worm infestation, constipation, neuropathic bladder , Sexual activity, Pregnancy.

The incidence of UTI in breast fed babies is less than formula fed.
C/F and Classification
1- Pyelonephritis
is characterized by any or all of the following
Abd pain(flank), fever(may be the only manifestation), malaise, nausea, vomiting, and accocianly diarrhea, in newborn and infant, nonspecific (irritability, jaundice, poor feeding, weight loss).
Pyelonephritis is the most common serious bacterial infection in infants <24 mo of age who have fever without an obvious focus
Renal damage, if no called pyelitis
2- Cystitis
Baldder involvement, dysurea, frequency, urgency, malodorous urine, no renal damage, no fever
3- Asymptomatic bacterurea
+ve urine culture but no manifestation, benign condition , no treatment require except in pregnancy