Clinical Reference Systems: Pediatric Advisor 10.0

Description

Pyelonephritis is an infection of the bladder which then moves up to the kidneys. It is a type of urinary tract infection (UTI). It is important to treat UTIs so that the kidneys are not damaged.

Kidney infection usually causes the following symptoms:

• painful urination
• foul-smelling urine
• fever
• backaches (in the kidney area below the ribs)
• stomachaches (especially lower abdomen)
• vomiting.

Cause

Urinary tract infections are caused by bacteria. The bacteria enter the bladder by traveling up the urethra. In general, the urethra is protected, but if the opening of the urethra (or the vulva in girls) becomes irritated, bacteria can grow there. Common irritants are bubble bath and shampoos. Careless wiping after a bowel movement might also cause irritation. A rare cause of UTIs (1% of girls and 5% of boys) is obstruction of the urinary tract, which results in incomplete emptying of the bladder.

Pyelonephritis is caused by infected urine moving back up the tubes (ureters) that connect the kidneys to the bladder. This is called reflux.

Reasons for Admission to the Hospital

Main complication: ________________________________________.

__ Needs IV fluids.

__ Needs IV antibiotic or other medication.

__ Other reasons: _________________________________________.

Expected Course

With treatment, your child's fever should be gone and symptoms should be better by 48 hours after starting the antibiotic. The chances of getting another UTI are about 50%. Read the advice on preventing UTIs to decrease your child's risk.

Requirements for Discharge

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

Discharge Instructions for Home Treatment

1. Antibiotics

   Your child's antibiotic is ___________________________. Your child's dose is ________ given ____ times a day during waking hours for ____ days. This medicine will kill the bacteria that are causing the UTI.

   If the medicine is liquid, store it in the refrigerator and shake the bottle well before you measure a dose. Use a measuring spoon to be sure that you give the right amount.

   Try not to forget any of the doses. If your child goes to school or a baby sitter, arrange for someone to give the afternoon dose. Give the medicine until all the pills are gone or the bottle is empty. Even though your child will feel better in a few days, give the antibiotic for the full 10 days to keep the UTI from flaring up again.

2. Other medicines
   • For pain or fever over 102ƒF (39ƒC) give _______________________
   • ______________________________________________________
   • ______________________________________________________

3. Extra fluids

   Encourage your child to drink extra fluids to help clear the infection.

4. Instructions for collecting a midstream, clean-catch urine specimen at home

   About 2 weeks after your initial visit your physician will want to see your child for another urine culture. Because the chances are high that your daughter will develop a second infection (50% of cases), your physician will probably also want to check her urine 1, 4, and 12 months after the first infection has cleared up.

   If you are asked to bring a urine sample to your physician's office, try to collect the urine when your child first urinates in the morning. Use a jar and lid that have been sterilized by boiling for 10 minutes.

   Wash the genital area several times with cotton balls and warm water. Your child should then sit on the toilet seat with her legs spread widely so that the labia (skin folds of the vagina) don't touch. After she starts to urinate into the toilet, place the clean container directly in line with the stream of urine. Remove it after you have collected a few ounces but before she stops urinating. (The first or last drops that come out of the bladder may be contaminated with bacteria.)

   Keep the urine in the refrigerator until you take it to your physician's office. Try to keep it chilled when you bring it to the office (that is, put the jar in a plastic bag with some ice).

5. X-ray studies

   Your child will need special studies to look at the kidney and bladder system to be sure there is nothing blocking it. If the doctor finds there is a blockage, your child may need surgery to prevent the infection from coming back.

6. Additional instructions
   • ______________________________________________________
   • ______________________________________________________
   • ______________________________________________________

Prevention of Urinary Tract Infections

• When your child bathes, wash the genital area with water, not soap.
• Don't use bubble bath before puberty; it's extremely irritating. Don't put shampoo or other soaps into the bathwater. Don't let a bar of soap float around the tub.
• Keep bathtime less than 15 minutes. Your child should urinate after baths.
• Teach your daughter to wipe herself correctly from front to back, especially after a bowel movement.
• Try not to let your child become constipated.
• Encourage your child to drink enough fluids each day to keep the urine light-colored.
• Encourage your child to urinate at least every 3 to 4 hours during the day and not "hold back."
• Your daughter should wear loose cotton underpants. Discourage wearing underpants at night.

Follow-Up Appointment after Discharge

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call the doctor if you have any concerns.

Call Your Child's Physician Immediately If:

• Your child starts to vomit the medicine.
• Back pain or fever return.
• Your child starts acting very sick.

Call Your Child's Physician During Office Hours If:

• You have other concerns or questions.