Questions posted in the
The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.
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Subject: Re: Allie recurrent UTI My daughter is 3 years old and has had 5 UTI's in the last 16 months. Her last culture and sensativity showed her to have enterococcus and was on a 14 day course of Macrodantin, 1tsp 4x/d for 7 days and 1tsp. at bedtime for another 7 days. The last 3 UTI's have all been approxi- mately within 3-4 weeks of each other. Within 4 hours of the onset of symptoms with her most recent UTI, she had frank bleeding which lasted for 3 days until not visably seen by the eye. Her C&S also showed to have 2+ bacteria and 3+ blood. Her infections are accompanied by fever, no greater than 101F, flank and back pain, urgency and frequency. An ultrasound and VCUG have all come back within normal limits showing no anatomical defects or difficulties with reflux. I should also add that she is allergic to PCN. We were refered to a pediatric urologist who suggested we give her a 6month trial of Septra DS, one tsp at bedtime. Her urinalysis at the urologists office showed no blood or signs of in- fection but was positive for a small amount of ketones. I am very con- cerned about an enterococcal infection in an otherwise healthy 3 year old child with progressive worsening of symptoms with each new infection. I am concerned about future scarring of her kidneys, or long term effects of being on prophylactic antibiotics for 6 months. The urologist did not want any further testing at this time. Are there any other tests or suggestions you could make as to why this type of infection and how best to treat it. We have tried all conventional methods and treatments as far as cranberry juice, increasing fluid intake, showers and not baths, and I take care of hygiene and wiping, etc. I would appreciate any further input or suggestions. Thank you, Julie
___ Dear Cyndi, Yes, it is possible that a scar may not be visualized after an infection of the kidney for many months. In fact, I would not order a follow-up ultrasound or nuclear scan(DMSA) to look specifically for a renal scar for at least six months after the infectious episode. To address the protein in the urine, it sounds like the protein that is being detected was from a dipstick analysis. Dipstick analysis often is imprecise. If your child has persistent protein in the urine or has medical problems suggestive of a protein losing condition, you may discuss with your family doctor possibly seeing a nephrologist, to properly work -up protein in the urine. A twenty-four hour urine collection at her age would be very difficult, but there are ways of evaluating a spot urine with ratios. To address the hematuria, a microscopic urinalysis needs to be performed. If there is a persistent amount of RBCs in the urine(>3 RBC/HPF), a full work-up consisting of a KUB, ultrasound(already done) and possibly cystoscopy. Labs include Sickle cell prep, ASO, IgA,IgG, C3 complement level, urine myoglobin, urine casts, PT,PTT. Most common cause of pediatric microhematuria is glomerulonephritis. Before you panic, get the baseline urinalysis and speak with your family doctor to see if this work-up is necessary. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568). Sincerely, | |
