In my last post (Urinary Tract Infections in Children – Part I) I discussed the importance of urinary tract infections, how they might present in children of various ages, and testing to verify the presence of these infections. This post will pick up with further diagnostic measures and treatment.
Once an appropriate sample of urine is obtained, it will then be analyzed in two different ways. A chemical analysis and microscopic exam is done to see whether those elements that might suggest urinary tract infection are present; white cells, protein, blood, etc. The second thing that is done with the urine is to take a culture specimen of the urine and attempt to grow bacteria out of it. This is the true litmus test for urinary infections, as chemical analysis might suggest infection but if there is no bacteria in the urine no true infection is present. The culture can take up to 3 days for a result and therefore in a child who has typical symptoms, the use of an antibiotic may be decided temporarily on the urinalysis alone until the results of the culture are available. A simple bladder infection, which is much more common than a kidney infection can be easily treated with a short course of antibiotics, during which time the symptoms usually resolve completely. Kidney infections, if severe, may take a lot longer and may require intravenous antibiotics.
If a child gets a significant number of infections over a relatively short period of time, or an individual infection appears to be very severe, or a significant infection occurs in an infant or very young child, then it is necessary to explore the problem much deeper in terms of further testing the child. This can be done in one or more ways to be determined by your doctor and the radiology department;
One method is a simple non invasive sonogram wherein a sound waves “picture” is taken of the entire urinary tract. Another method is called a VCUG, voiding cysto-urethrogram in which a small catheter is placed into the bladder through the urethra (the exit from the bladder to the outside), a small amount of dye is placed in the bladder in order to outline the anatomy of the lower urinary tract( bladder and ureters -tubes that go from the kidney to the bladder). A functional picture of the lower tract can be obtained by radiologocally “watching” during and after urinating. Two further tests can be done to more clearly evaluate the anatomy and function of the kidneys. Both involve the injection into the blood stream of a substance that will be taken up by the kidney, delineating structure and function.
A history of repeated urinary tract infections is not an uncommon problem. If something has been found that can be surgically corrected to prevent further infections, this choice may be made. This situation is less common than finding nothing abnormal on the testing in a child who still gets repeated infections. Certainly this situation, as in anyone with repeated infections, will need to be monitored very carefully by your Doctor.
The bottom line in handling urinary infections is to prevent them from ascending up the urinary tract and potentially injuring the kidneys, for this will ultimately lead to a certain amount of loss of function of the kidneys; something better prevented than treated.
This is something I’ll always keep a close eye on, I used to get them all the time as a kid!