Urinary Tract Infection

Urinary Tract Infection

Signs and Symptoms
Diagnosis
Treatment

Diagnosis

We first talk with your child and yourself about her or his health in general and then about symptoms. We will perform a urinalysis, which involves looking at your child's urine with a microscope. To be certain that there is an infection, we also will do a urine culture to see if bacteria from the urine will grow in a culture medium. Your doctor will have the results of the urine culture after 24 hours. If infection is present, an additional 24 hours usually is necessary to find out which antibiotic will kill all of the bacteria.

The method of urine collection will affect the accuracy of the urine culture. It is important to:

• Wash the skin around the urethra with a cleaning pad to remove bacteria on the skin surface.
• If urine is collected at home, place the urine sample in the refrigerator and then pack it in ice while traveling to the doctor's office.

To collect urine from infants and toddlers, a special bag is placed over the genital area to collect urine. Because bacteria from the skin may contaminate these samples, it sometimes is necessary to insert a small plastic tube called a catheter through the urethra into the bladder to obtain a clean specimen.

Children who have confirmed urinary tract infections should have an X-ray evaluation. This is especially important for infants and toddlers, since most of them will develop another urinary tract infection later. Waiting until a child has had two or more urinary tract infections before X-ray evaluation increases the risk of permanent kidney damage or scarring. Abnormalities of the urinary tract occur in 25 percent to 50 percent of children with documented urinary tract infection.

We also test for vesicoureteral reflux, the abnormal back flow of urine from the bladder into the ureter and up to the kidney. Reflux is dangerous because it allows bacteria that might be in the bladder to reach the kidney. This can cause a kidney infection and lead to kidney damage.

Here are some of the basic tests we may suggest if your child has a urinary tract infection:

• Voiding Cystourethrogram (VCUG) -- This test gives us important information about the shape and size of the bladder, the bladder neck or opening and the tubes, called ureters that drain the urine from the kidneys into the bladder.

  A small plastic tube is inserted into the urethra so that a fluid called contrast media can flow into the bladder. While your child's bladder is filling, he or she can watch a video. We encourage children to bring along their favorite one, and we always have a few others, like The Lion King, on hand. Pictures are taken while your child's bladder is filling. When your child's bladder is full, we remove the catheter and take a picture as he or she urinates. After the study is done, we will review the films with you and your child. Together we will discuss a plan of care.

  This procedure is not painful per se, but some discomfort may occur when the tube is placed. Most of all, the experience may be perceived by your child as scary and certainly unusual. Your child will take his or her cues from you, feeling more comfortable if you are. It is most important that at least one parent remain with your child in the room at all times. We will explain everything as we go. The more detailed literature will discuss strategies to help minimize your child's anxiety during this study. The test usually takes 20 to 30 minutes.

• Kidney and Bladder Sonogram (Ultrasound) -- Otherwise known as "jelly-on-the-belly." This test is done to outline the kidneys, ureters and bladder. It looks for additional urinary tract defects that could be the cause of infection. The test doesn't require radiation and is painless.

• Kidney (Renal) Scan -- This test may be done if the above tests are abnormal. It is used to better demonstrate the actual function and drainage of the kidneys. A kidney scan also can show if there is kidney damage and scarring.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007