Urinary tract infection means that there is bacteria in the kidney or urinary tract and this bacteria multiplies. Urinary tract infection is a common and important problem of childhood. Especially when the inflammation is in the kidney (pyelonephritis), it often causes symptoms such as high fever, nausea, vomiting, and if it is not treated properly in time, it leaves scar tissue (scar) in the kidney as it heals and may lead to life-affecting negative consequences such as high blood pressure and kidney failure in later life.
Infection in the lower urinary tract, such as in the bladder (cystitis), does not often progress with fever, but rather causes symptoms such as burning in the urine, frequent urination and a feeling of urgency. Cystitis does not lead to hypertension or kidney failure in the future.
However, since it is difficult to distinguish pyelonephritis and cystitis in young children, especially children under 2 years of age, based on clinical symptoms, it would be appropriate to treat all of these children as if the inflammation were in the kidney (pyelonephritis).
Circumcision of boys significantly reduces the risk of urinary tract infection.
In children, a bacterium that enters the urinary tract from below usually moves upward, causing an infection up to the kidney. Therefore, in the presence of reflux (Vesico-ureteral reflux - VUR), which causes some of the urine to go up to the kidney due to the increasing pressure in the bladder during urination, bacteria entering the urinary tract from below easily reach the kidney. Thus, febrile urinary tract infection (pyelonephritis) frequently recurs in children with reflux (VUR) and the risk of developing hypertension and kidney failure in the future increases.
In infants and young children, sometimes fever may be the only symptom of urinary tract infection. If the temperature is above 390C, the possibility of urinary tract infection is higher. Apart from fever, vomiting, diarrhea, difficulty feeding and foul-smelling urine are also symptoms of urinary tract infection.
Symptoms of urinary tract infection in older children include fever, painful urination, sudden urge to urinate (urgency), frequent urination, night urination. urinary incontinence, hematuria (blood in the urine) and abdominal pain. Fever, chills and flank pain indicate pyelonephritis (kidney inflammation) in older children.
Diagnosis of urinary tract infection. It is diagnosed by detecting leukocytes (white inflammatory cells) and leukocyte clusters in the microscopic examination of urine and bacterial growth in a clean urine culture. Urine dip sticks also give an idea about urinary tract infection.
For the treatment of urinary tract infection, antibiotics (preferably the antibiotic to which the bacteria are sensitive in the culture-antibiogram) are given in the appropriate dose, for a sufficient time and by the appropriate route. Babies who are constantly vomiting, have fever and are seriously ill are hospitalized and treated.
Since the risk of re-infection is high after the treatment is completed, patients must come for check-ups at regular intervals. Urinary system ultrasonography should be performed on patients to investigate abnormalities in the kidneys and urinary tract.
Voiding cystourethrography (MCUG-VCUG) should be performed in every child who has two or more febrile urinary tract infections to rule out reflux, which causes urinary tract infection and recurrence. In addition, cystourethrography should be performed in children with any structural abnormality detected on renal ultrasound or scarring on DMSA scintigraphy.
Although its benefits are controversial, suppression therapy with oral low-dose antibiotics is applied by many experts to prevent recurrence of infection in children with recurrent urinary tract infections.
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