Urinary Tract Infections (Complications and Tests)

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This information leaflet is for parents of children who have had a urinary tract infection. It explains why it is important to investigate your child with these tests.

Who needs to be tested?
Some children with a urinary tract infection will have an abnormality of the renal tract and occasionally this may lead to a problem with the kidneys. We cannot tell which children with a urinary tract infection will have a kidney problem. Certain factors increase the risk of a renal tract abnormality. If any of these are present, your child may need to have further tests.

Why is it important to know if there is a kidney problem?
If we do nothing about a kidney problem then the damage can get worse with further infections and may lead to kidney failure as a young adult.

The most common kidney problem is caused by ‘reflux’. Normally, when a child passes water (urine), it is produced in the kidneys and travels down through the ureters to the bladder and then out
through the urethra in one direction, special valves stop it going backwards. If these valves are not working properly then the urine can go backwards up into the kidneys; this is called ‘reflux’. This increases the risk of a urine infection affecting the kidneys leading to kidney damage.

The tests for reflux
The doctor will discuss the tests with you and suggest different tests depending on:
• Whether your child is a girl or a boy.
• How old your child is.
• The organism causing the UTI.
• Whether this is the first UTI or a recurrence.

Please ask questions if you are not happy or are unsure about anything.

• You can stay with your child throughout the tests.
• Depending on the age of your child he/she will need a prescription of low dose antibiotics. This is given at night and should help to prevent any further infection. Your child will need to continue with preventative antibiotics until all the test results are back.
• The risk of side effects and complications from these antibiotics are very small.

The tests may include one or more of the following:
Ultrasound examination
• This test is simple and painless.
• Your child will lie on a couch for about 10 minutes while the doctor or radiographer scans the kidneys and bladder. He/she will put a thick layer of gel on the skin and slide a small hand held instrument over the area.
• Ideally the bladder should be full for this scan, so please drink plenty beforehand. If your child can’t wait to go to the toilet while you are waiting, please tell the receptionist and it may be possible for the scan to be fast forwarded.
• After this first scan your child may be asked to go to the toilet and then a second scan may be performed with the bladder empty.
• Although major abnormalities and most blockages can be seen on this scan, certain problems cannot be detected, and therefore further tests may be needed.

Micturating cystourethrogram:
• That is a long word for an x-ray of the bladder. This test is done to check for reflux (when some of the urine goes the wrong way because the valves are not working properly).
• It involves passing a catheter (a fine tube) via the urethra into the bladder.
• A harmless liquid which shows up on Xray is then put into the bladder through the catheter and x-ray pictures are taken.
• It is important for the child to have someone they know well in the x-ray room with them for reassurance.
• You will receive instructions for your child to increase the dose of the antibiotic they are taking the day before the test and for two days following the test
• You will receive a more detailed leaflet about this test.

DMSA scan (performed at Northampton General NHS Trust)
The DMSA (Dimercaptosuccinic Acid) Scan is usually performed 4-6 months after the last UTI. This involves an injection of a tiny amount of isotope (radioactive substance) into a vein in the hand (after it has been numbed with anaesthetic cream). After about three hours your child will have a scan of the kidneys to see how well they are working. This scan takes about 20 minutes and involves lying very still and is painless. This test will show if there are damaged areas or scars on the kidneys. You will receive more information about this with your appointment letter from
Northampton Hospital.

Results of the tests:
The Ultrasound results will be discussed with you at your Outpatients appointment, or via a letter, as will any decisions on further treatment that might be required.

What treatment is available for reflux?
The treatment usually consists of a small amount of antibiotic at night over a period from 6 months to a few years depending on the individual child. Generally this can be stopped by the time the child is five years old. The medication should prevent recurrent infection occurring. Children with recurrent UTI and renal parenchymal defects will need long term follow-up of growth, blood pressure and urine dipstix for proteinuria.

Are there any risks?
The risk of side effects from taking antibiotics are very small; the risk from urine infections is much greater. Occasionally further investigations may be required +/- referral to a nephrologist.

Further Information
Ward 5 Telephone No: 01908 996377
Paediatric Community Nurses Telephone No: 01908 996518
Paediatric Day Assessment Unit Telephone No: 01908 996356
Milton Keynes University Hospital Telephone No: 01908 660033 and ask to speak to your Consultant Paediatrician’s secretary (their name can be found on your Appointment Card).