Infecções do trato urinário em crianças
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- febre >39°C (>102.2°F)
- irritabilidade (neonatos e lactentes)
- baixa aceitação alimentar (neonatos e lactentes)
- sensibilidade suprapúbica
- sensibilidade no ângulo costovertebral
Other diagnostic factors
- urina de odor pútrido (lactentes, crianças maiores e adolescentes)
- disúria (idade pré-escolar, crianças maiores e adolescentes)
- polaciúria (crianças maiores e adolescentes)
- dor abdominal/no flanco (lactentes, crianças maiores e adolescentes)
- vômitos
- aparência doente (neonatos)
- hematúria macroscópica (crianças maiores e adolescentes)
- novo episódio de incontinência urinária (crianças menores, crianças mais velhas e adolescentes)
Risk factors
- idade <1 ano
- sexo feminino
- meninos incircuncisos no primeiro ano de vida
- ITU prévia
- disfunção vesical e intestinal
- refluxo vesicoureteral
- atividade sexual
- ausência de história de amamentação
- anormalidades anatômicas ou cirurgia prévia do trato urinário
- imunossupressão
- desnutrição energético-proteica
Diagnostic investigations
1st investigations to order
- tira reagente para exame de urina
- microscopia da urina
- urocultura
Investigations to consider
- citometria de fluxo da urina
- hemocultura
- hemograma completo
- marcadores inflamatórios
- urocultura para fungo
- creatinina sérica, ureia e eletrólitos
- ultrassonografia renal e/ou vesical
- cintigrafia com ácido dimercaptossuccínico (DMSA)
- cistouretrografia miccional
Treatment algorithm
refluxo vesicoureteral: sem história de ITUs febris
idade ≤2 meses
idade >2 meses
ITUs recorrentes
Contributors
Authors
Joana Dos Santos, MD, MHSc, FRCPC
Assistant Professor of Pediatrics
Medical Pediatric Urologist
The Hospital for Sick Children
Toronto
Ontario
Canada
Disclosures
JDS declares that she has no competing interests.
Acknowledgements
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.
Disclosures
BG, FK, MAJ, and RV declare that they have no competing interests.
Peer reviewers
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
Disclosures
MK declares that he has no competing interests.
Daniel T. Keefe, MD, FRCSC
Pediatric Urology Fellow
The Hospital for Sick Children
Toronto
Ontario
Canada
Disclosures
DTK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
European Association of Urology. Guidelines on paediatric urology. 2023 [internet publication].Full text
National Institute for Health and Care Excellence. Urinary tract infection in under 16s: diagnosis and management. Jul 2022 [internet publication].Full text
Mattoo TK, Shaikh N, Nelson CP. Contemporary management of urinary tract infection in children. Pediatrics. 2021 Feb;147(2):e2020012138.Full text Abstract
American College of Radiology. ACR appropriateness criteria: urinary tract infection - child. 2023 [internet publication].Full text
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].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Apendicite
- Gastroenterite
- Doença de Kawasaki
More DifferentialsGuidelines
- Paediatric urology: urinary tract infections in children
- Appropriateness criteria: urinary tract infection - child
More GuidelinesPatient information
Infecções do trato urinário em crianças
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