Pediatric urination

Introduction to pediatric urination Urinary tract infection (referred to as urinary sensation) is inflammation caused by bacteria directly invading the urinary tract. Infection can involve the upper and lower urinary tract, and the difficulty of positioning is collectively referred to as urinary sensation. Symptoms are divided into acute and chronic. The former is acutely ill and the symptoms are more common and easy to diagnose. Chronic and recurrent infections can cause kidney damage. Repeated infection in children, often accompanied by abnormal urinary structure, should carefully find the cause, relieve congenital obstruction, prevent kidney damage and scar formation. basic knowledge The proportion of illness: 0.001% Susceptible people: young children Mode of infection: non-infectious Complications: renal empyema, perirenal abscess

Pediatric urinary cause

1, the cause of urinary sensation in children

(1) Physiological characteristics: Because the baby uses diapers, the urethra is often contaminated by feces, and the local defense ability is poor, which may cause ascending infection. The girl's urethra is shorter, and the baby's body has poor antibacterial ability and is prone to bacteremia. Lead to down infection.

(2) congenital malformation and urinary tract obstruction: the former is more common than adults such as stenosis of the ureter and ureteral junction, hydronephrosis, posterior urethral valve, polycystic kidney disease can cause poor drainage and secondary infection, in addition to neurogenic bladder , stones, tumors and other obstruction, in the trap medical center with urethral malformations can account for 25% to 50% of total urinary tract infections.

(3) vesicoureteral urinary reflux (referred to as urinary reflux): common in infants and young children, foreign introduction of urinary tract infection in children under 10 years old, 35% to 60% have urinary reflux, but few domestic reports Further observation is needed. Under normal circumstances, a section of the ureter is running in the bladder wall. When the urine in the bladder is filled and urinated, the bladder wall presses the urinary catheter to close it, and the urine cannot flow back. In early childhood, due to the short ureter in the bladder wall, many children are incompletely closed during urination and return to the flow. The bacteria cause infection with reflux. The harm of urinary reflux is caused by reflux nephropathy and kidney scar formation. In children under 5 years of age, the degree of reflux is directly proportional to the scar of the kidney. Mild reflux can disappear with age, but severe reflux requires more surgical treatment. Therefore, the presence or absence of reflux in children with urinary tract infection is detected. It is of great significance for the diagnosis and guidance of treatment.

2, pathogenic bacteria

80% to 90% are caused by enterobacteria. In the first cases of primary urinary tract, the most common is Escherichia coli, followed by Proteus, Klebsiella and E. coli, and a few are Streptococcus faecalis. And Staphylococcus aureus, etc., caused by viruses, mycoplasma or fungi, more than 90% of E. coli isolated from children with acute pyelonephritis are P umbrella strains, and the adhesion of P-fimbriae is considered to be microorganisms The reason for the ascending, incomplete treatment or abnormal urinary tract structure, bacteria are prone to drug resistance, can cause repeated infection, prolonged unhealed, turn chronic, sometimes due to the action of antibiotics, bacteria produce variability, cell membrane rupture, can not Maintain the original state, but still survive in the high osmotic environment of the kidney medulla. If the drug is stopped too early, the bacteria can still be caused by the original state, and the bacteria does not grow in the general medium, only in hypertonicity. The nutrient medium grows, so the clinical symptoms of chronic pyelonephritis are not improved, and those who have repeated negative urine culture should be cultured at the same time to clear the pathogen.

3, the route of infection

1 ascending infection is more common in girls;

2 blood infections occur mostly in newborns and small babies, common in the course of impetigo, pneumonia, sepsis;

3 a small number can be caused by the lymphatic pathway and adjacent organs or tissues directly affected;

4 urinary tract examinations can also be used as a route of infection.

Pediatric urinary prophylaxis

To prevent urinary tract infections in children, the following should be noted:

(1) Wash the vulva every day, change the underwear frequently, and do not wash the vulva with water for washing the feet.

(2) The baby should clean the anus after daily stool; the diaper should be boiled with boiling water after cleaning. It is best to boil and disinfect the condition. The towel and washbasin for the baby should be separated from the adult.

(3) Thorough treatment of ascariasis.

(4) Do not let children urinate, because the urine is too long in the bladder, on the one hand, it is easy to make bacteria multiply; on the other hand, long-term filling of the bladder will reduce the contraction ability of the bladder muscle, and the urine is not easy to empty. Both are the cause of urinary tract infections.

(5) Minimize the time for children to wear open pants.

(6) It is found that children have congenital malformations of the urinary system and should be treated surgically.

(7) Enhance children's resistance and reduce various infection opportunities.

Pediatric urinary tract complications Complications, renal empyema, perirenal abscess

1, kidney empyema

Renal empyema, also known as pyonephrosis, refers to a pyogenic infection that causes extensive destruction of the renal parenchyma to form a abscess. It is often associated with infective hydronephrosis, kidney stones and pyelonephritis, especially with urinary tract obstruction. It is more likely to occur when the lesion is present. The clinical manifestations are mainly chronic pyuria and systemic consumption symptoms, such as fatigue, weakness, weight loss, malnutrition, anemia and fever. Sometimes, due to the extremely narrow and even occlusion of the ureteropelvic junction, there may be no urinary tract in the later stage. Symptoms, but mainly as a lumbar mass, but a careful inquiry can detect the history of urinary tract infection in the past, intravenous pyelography showed loss of renal function on the affected side, ultrasound examination can detect cystic mass, application of antibiotics and blood transfusion, etc. After the general improvement of the treatment, nephrectomy can be performed. Due to severe adhesion and scarring of the surrounding tissues of the kidney, general nephrectomy sometimes encounters great difficulty and requires subcapsular nephrectomy.

2, perirenal inflammation

Perinnephritis (perinnephritis) is also known as perirenal abscess. Although it is rare in pediatrics, it can occur in all ages. The infected part is in the adipose tissue around the kidney. It is mostly unilateral, and the pathogen is often Staphylococcus aureus. From the lesion through the blood flow, lymph to the surrounding of the kidney, especially the skin infection is often the primary lesion, can also be directly transmitted by the renal parenchyma infection and the surrounding tissue of the kidney, the symptoms are mild, the severe disease is high fever, Chill, nausea, vomiting, low back pain and upper abdominal pain, sometimes pain can affect the abdominal wall or lower limbs, the lesion stimulates the psoas muscle, causing the psoas muscle tendon and the hip joint flexion, so the lower extremity can not be straightened, white blood cells increase, and urine routine The examination is often normal. When the disease and pyelone are present at the same time, there will be symptoms such as frequent urination and pyuria.

B-mode ultrasound examination is helpful for diagnosis. X-ray examination can not determine the diagnosis, but it is very helpful. The kidney and psoas muscles are unclear, the spine is bent to the affected side, and the pelvis is seen when breathing. The treatment is mainly antibacterial drugs combined with local hot compress or drug application and liquid supplementation, etc. If there is pus formation, the drainage can be cut after puncture confirmation.

Pediatric urinary symptoms Common symptoms Urinary urgency, urinary frequency, chills, sleepiness, proteinuria, fatigue, pyuria, hematuria, edema with proteinuria

1, urgency urinary tract infection

It refers to the course of the disease within 6 months. The symptoms vary according to age and location of infection. Older children are similar to adults. The younger the age, the more obvious the systemic symptoms are. The symptoms of local urination are more or less neglected.

(1) Neonatal period: caused by blood infection, the symptoms are different, mainly due to systemic symptoms, such as fever, poor milk, pale, vomiting, diarrhea, abdominal distension and other non-specific manifestations, most children may have growth and development Stagnation, slow weight gain, some sick children may have convulsions, lethargy, and sometimes jaundice, but the general local urination symptoms are not obvious, so to improve the vigilance of this disease, for unexplained fever should be early urine routine examination and quiet Blood culture to confirm the diagnosis.

(2) Infant and young children: still mainly systemic symptoms, such as fever, mild cough, repeated diarrhea, etc., urinary frequency, urgency, dysuria and other urination symptoms gradually become more obvious with age, crying when urinating, quietly or stubborn Sexual diaper rash should think of this disease, and even jaundice can occur.

(3) Childhood: When the lower urinary tract infection is more than urinary frequency, urgency, dysuria and other urinary tract irritation, sometimes there may be terminal hematuria and enuresis, but the systemic symptoms are not obvious, but the upper urinary tract infection Systemic symptoms are more obvious, manifested as fever, chills, general malaise, may be associated with low back pain and kidney pain, and may be accompanied by urinary irritation, some patients may have hematuria, but proteinuria and edema are not obvious, generally not Affecting renal function, such as incomplete or recurrent episodes or urinary tract obstruction, deformity and other factors can be converted to chronic.

2, chronic urinary tract infection

Refers to the course of disease for more than 6 months, the condition is prolonged, the symptoms vary from mild to severe, from no obvious symptoms to renal failure (first impaired concentrating function), repeated episodes can be characterized by intermittent fever, backache, fatigue, weight loss, Anemia, etc., local lower urinary tract irritation symptoms may be absent or intermittent, pyuria and cellular urine may or may not be obvious, sick children with sedative reflux or congenital urinary tract structural abnormalities, B-mode ultrasound or intravenous pyelography can be seen Kidney scars, if early treatment can reduce kidney damage.

Pediatric urine test

1, urine specimen collection

After the vulva is cleaned, it is washed with 1:1000 petals, and the middle urine is sent for examination. Because it is simple and easy to use, it is the most commonly used method for urine retention. Small infants can be fixed in the vulva with urine plastic bags, but such as 30 Minutes are not left in the urine stream and need to be disinfected again. There is a risk of introducing bacteria into the catheter. Generally, it is not used. The suprapubic bladder puncture is performed under completely aseptic conditions. The result is reliable. If the result is suspicious in the middle part of the urine or the result of the catheterization, Adoption, this method is simple and safe, and only 0.6% of hematuria within 24 hours after surgery.

2, urine routine

Cleaning the middle part of the urine sediment leukocytes> 5 / HP should be considered for urinary tract infections, such as leukocyte aggregation or see white blood cell cast and proteinuria, the diagnosis value is greater, the latter two can explain the kidney involvement, but only Detection of leukocyte stems is not sufficient to diagnose upper urinary tract infections.

3, urine culture and colony count

It is an important basis for the diagnosis of this disease. Although it is sterile in normal bladder, it can be contaminated by bacteria during urination. In healthy middle-aged urinary culture, 60%~70% of bacteria can grow bacteria, and 38% of catheter cultures can have bacteria, but There are fewer colonies, so it is often wrong to make a diagnosis based on the presence or absence of bacterial growth. Colony counting must be performed at the same time. The colony count of 100,000/ml or more can be diagnosed as urine sensation, and 1 to 100,000/ml is suspect, less than 1 10,000/ml multi-lineage girls such as secondary urine culture colonies are above 100,000 / ml, and the same bacteria can determine the diagnosis, boys such as urine specimens are non-polluting, colonies above 10,000 / ml, that should be considered For the diagnosis of urine, taking fresh urine is very important for culture. If it cannot be cultured immediately, it should be placed in a refrigerator at 4 °C.

4, direct smear of urine to find bacteria

Use a drop of freshly mixed urine, dry on a glass slide, and stain with Methylene Blue or Gram. If you can find more than one cell under the oil mirror, it means that the bacteria in the urine are above 100,000/ml. The method is simple and rapid, has certain reliability, and is meaningful for diagnosis.

5, bacteriuria auxiliary examination

Commonly used nitrite reduction test, can be used as a screening test for this disease, the positive rate can reach 80% ~ 90%, this method is simple, reliable, no false positive, but such as lack of nitrate in the urine; a large number of diuretic or antibiotics It can be negative.

Diagnosis of urinary sensation in children

diagnosis

Typical cases can be diagnosed according to symptoms and laboratory tests. The symptoms of elderly children are similar to those of adults. The symptoms of local urination are obvious, so it is easier to diagnose. However, the symptoms of urination in infants and young children are not obvious, and it is easy to be misdiagnosed. Check urine, and strive to perform urine culture, bacterial count and drug sensitivity test before treatment with antibacterial drugs.

Anyone who has confirmed this disease should further clarify whether it is the first infection or recurrence, whether it is upper or lower urinary tract infection, whether there is abnormal urinary tract structure, and the difficulty in locating urinary sensation in children can refer to clinical symptoms, renal function and urine. Regular inspection for identification.

Differential diagnosis

1, glomerulonephritis: acute nephritis in the early stage may have mild urinary tract irritation, urinary routine examination of red blood cells, a small number of white blood cells, but more tube type and proteinuria, and more with edema and hypertension, urine culture negative Help identification.

2, kidney tuberculosis: more common in older children, there is a history of tuberculosis exposure and tuberculosis infection symptoms, tuberculin test positive, such as lesions involving the bladder can appear hematuria, pyuria and urinary tract irritation, can be found in urine Intravenous pyelography showed destructive lesions of the renal pelvis and renal pelvis.

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