possible UTI, VCUG and toddler

[nlada]

My daughter is 13 months old. Recently she had a fever without any other symptoms, i took her to her doctor, he checked her ears, throat, everything was fine, tooks a urine sample and found some blood in it under the microscope (red and white cells), so he suspected UTI, decided to check it for bacteria in the lab and told me to start her on antibiotics right away. In the lab they found a trace of multiple bacterias, so the doctor told me to continue giving her antibiotics. The result of her urine test makes me suspicious because the sample was definitely contaminated as it was in contact with her skin - they used a plastic bag that was stuck to her diaper area, the bag was full and the content was in contact with her skin. What I am really concerned about is that her doctor highly recommends to make another test - a voiding cystourethrogram (VCUG)  to check for the reflux. I don’t want to expose her to radiation and invasive procedures at such an early age without much reason. Her fever started in a week after the MMR shot, this is when the side effects of the shot are expected to appear. As far as I know blood in urine could accompany the fever not matter what the reason of the fever was. Her doctor advised to keep her on a low dose of antibiotics untill we decide to do the test, he said there is no other way to check for the reflux and if she has a reflux she can never have an evident UTI or blood in urine again (infection can be “silent”), so the test can be the only way to save her kidney. I don’t like the idea of antibiotics either. We completed the 10 day course of antibiotics to treat her UTI (if she had one) and I don’t give her anything else right now.
Is the symptoms she had a really good reason for this test? Is there anything else can be done (less invasive, without or with less radiation)? Can blood in urine alone be a reason for the test? What are the risks if we don’t do anything right now and wait for another fever?

[help_help_uti]

My daughter who is 6 did a vcug. Went well but nothing was shown. Yes it is scray. I have been dealing with chronic uti's caused by ecoli organism. We did renal kidney scan . And all normal. Only thing they seen was little white flecks possible calcium sulfate. Still trying to find answer. I wish you the best. This can be a draining loonngggg road.

[kimwilliams76]

I am not a doctor, but I just wanted to say a somthing. My daughter is 4 years old. We have struggled with recurrent UTI's for 16 months now. She has had 10 UTI's. I partly agree with the doctor. I think you should wait to see if she has another fever. Maybe take her in for another urine culture in a month or so. The problem with that is, I think it should be a catheterized urine specimen as well. This can be stressful for you and the baby. However, it is what's best for her. A fever usually represents a kidney infection wich can damage the kidneys. That is somthing we don't want. That is probably why your doctor is suggesting the VCUG. The renal ultrasound will show if there has been any kidney damage so far. The problem I see is that she is only 13 months and cannot tell you she hurts. If she has  UTI it can go untreated and lead to a kidney infection. The bladder is strong and can stand these infections but the kidney's cannot. (and we need these) So, then again the VCUG will let you know if she does have reflux (wich is the leading cause for UTI's and kidney infections). I guess you take a risk either way you go. She is so young, that I don't think you will have much trouble with the VCUG. The procedure is no different from a catheterized urine collection except that it involves radiation. I understand your concerns about radiation, but atleast it's better than a damaged kidney. Also, catherization is uncomfortable and if is repeated many times may make it harder as she becomes more aware of what is going to happen. It may just be better for her to do the VCUG. Whatever you decide, if she continues to have them, be aggressive to find out what is happening. They may tell you she will out grow them, wich may happen, but make sure they do all they can. My cousin lost a kidney, and a friend of mine is dealing with infertility now as an adult that they think has to do with UTI's when she was younger. Now, I am dealing with trying to find out what's wrong with my daughter. Good LucK! I hope I have helped.

[Stephen Liroff, MD]

You bring up some interesting issues.
Certainly an abnormal urinalysis in a child with a fever of unclear cause would need treatment. Using a PUC (pediatric urine collecting device - the plastic bag to which you referred) is a standard, non-invasive way of collecting urine from a child. There is a high rate of false positives with it, however. By the time the report is returned, the child has been on treatment for several days and there is no way to recheck the urine at that point. A catheterized urine initially would have helped avoid the present issue. Certainly the u/a may have also been contaminated by the skin/vaginal fluids.
At this point I think that the most reasonable way to proceed is to obtain a renal ultrasound from a facility that is used to doing ultrasounds on children and, if the ultrasound is normal do a series of urine cultures. Here a PUC urine every month or two with a cath specimen obtained before treatment for any positive PUC samples would seem reasonable. If she does have a definite urinary tract infection, then she should undergo a voiding study.
If the ultrasound shows evidence of a problem, then I would obtain a voiding cystourethrogram (NOT a nuclear cystogram).
I think that the risk of waiting and observing her closely for another UTI is quite small.
S.A.Liroff,M.D.


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Vattikuti Urologic Institute.  Please consult your physician for diagnostic
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