Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- fever >102.2°F (>39°C)
- irritability (neonates and infants)
- poor feeding (neonates and infants)
- suprapubic tenderness
- costovertebral angle tenderness
Outros fatores diagnósticos
- foul-smelling urine (infants, older children, and adolescents)
- dysuria (preschool age, older children, and adolescents)
- urinary frequency (older children and adolescents)
- abdominal/flank pain (infants, older children, and adolescents)
- vomiting
- ill appearance (neonates)
- gross hematuria (older children and adolescents)
- new-onset urinary incontinence (toddlers, older children, and adolescents)
Fatores de risco
- age <1 year
- female sex
- uncircumcised boys in the first year of life
- previous UTI
- bladder and bowel dysfunction
- vesicoureteral reflux
- sexual activity
- no history of breastfeeding
- anatomic abnormalities or previous surgery to the urinary tract
- immunosuppression
- protein-energy malnutrition
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- urine dipstick
- urine microscopy
- urine culture
Investigações a serem consideradas
- urine flow cytometry
- blood culture
- complete blood count
- inflammatory markers
- fungus urine culture
- serum creatinine, BUN and electrolytes
- renal and/or bladder ultrasound
- dimercaptosuccinic acid (DMSA) scan
- voiding cystourethrogram (VCUG)
Algoritmo de tratamento
vesicoureteral reflux: no history of febrile UTIs
age ≤2 months
age >2 months
recurrent UTIs
Colaboradores
Autores
Joana Dos Santos, MD, MHSc, FRCPC
Assistant Professor of Pediatrics
Medical Pediatric Urologist
The Hospital for Sick Children
Toronto
Ontario
Canada
Declarações
JDS declares that she has no competing interests.
Agradecimentos
Dr Joana Dos Santos would like to gratefully acknowledge Dr Beatrice Goilav, Dr Frederick Kaskel, Dr Mary Anne Jackson, and Dr Rene VanDeVoorde, previous contributors to this topic.
Declarações
BG, FK, MAJ, and RV declare that they have no competing interests.
Revisores
Martin Koyle, MD, MSc, FAAP, FACS, FRCS(Eng), FRCSC
Professor
Department of Surgery and Institute of Health Policy, Management and Evaluation
Staff Pediatric Urologist
The Hospital for Sick Children
Toronto
Ontario
Canada
Declarações
MK declares that he has no competing interests.
Daniel T. Keefe, MD, FRCSC
Pediatric Urology Fellow
The Hospital for Sick Children
Toronto
Ontario
Canada
Declarações
DTK declares that he has no competing interests.
Referências
Principais artigos
European Association of Urology. Guidelines on paediatric urology. 2024 [internet publication].Texto completo
National Institute for Health and Care Excellence. Urinary tract infection in under 16s: diagnosis and management. Jul 2022 [internet publication].Texto completo
Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021 Feb;147(2):e2020012138.Texto completo Resumo
American College of Radiology. ACR appropriateness criteria: urinary tract infection - child. 2023 [internet publication].Texto completo
Peters CA, Skoog SJ, Arant BS Jr, et al; American Urological Association. Management and screening of primary vesicoureteral reflux in children: AUA guideline. 2017 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Appendicitis
- Gastroenteritis
- Kawasaki disease
Mais Diagnósticos diferenciaisDiretrizes
- Paediatric urology: urinary tract infections in children
- Guidelines on paediatric urology: urinary tract infections in children
Mais DiretrizesFolhetos informativos para os pacientes
Urinary tract infections in children
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