Suggest Treatment For UTI In An Infant

Posted on Tue, 27 Oct 2015

Question: My son is 2 months old and diagnosed with UTI at 6 weeks.
Negative MCUG.
Ultrasound result: both kidneys are normal in size
On the left the collecting system is very mildly dilated and there is mild dilation of the renal pelvis which measures 8 mm.slight prominence of the upper left ureter is noted. No cortical scarring is seen. Bladder looks normal and no lower ureteric dilation seen.
Very mild left pelvicalyceal dilation noted.
Please help on what's the treatment options and impacts and reasons for this condition?

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer:
Needs stenting

Detailed Answer:
Hello

Thanks for the query

UTI is extremely uncommon in children even more so in male infants. What your son is having looks like a congenital PUJ of a mild form, this explains why there is mild dilatation of renal pelvis and prominence of the ureter.

Here is how I would have gone about it

1. CT scan of the kidney, ureter and bladder
2. Based on the CT scan I would place a stent in the PUJ to relieve the obstruction, because mild dilatation is of no harm as long as there is no hydroureteronephrosis
3. If there is recurrence of UTI then I would place the child on prophylactic antibiotics

Most cases is these I have seen improvement by 2 years of age and they lead a normal symptoms free life, so please do not worry about it

I hope I was of help,if you have any further queries please get back to me

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Rakesh Madhyastha (7 hours later)

Thanks very much for the details response Dr XXXXXXX

My son is currently on Trimethoprim and the we are administering it every day until the next review with consultant.

how can be it be confirmed that he is having congenital PUJ as the scans during the pregnancy has not found this?

Does PUJ cures by itself when the baby grows older?

And is stents required always for this condition?

The pediatric consultant we saw has recommended three tests so far:

1) MCUG (Micturating cystourethrogram _ - which came back as negative (no issues)

2) Ultrasound - The results were given in the original question which found mild dilation.

3) DMSA (dimercaptosuccinic acid) - Due in january as they mentioned it requires mininum of 4 months between the test and date of infection.

Are these tests enough or do we need CT scan as you mentioned to find out more?

Looking forward for your reply,
Thanks,
xxxxx

Answered by Dr. Rakesh Madhyastha (16 hours later)

Brief Answer:
DMSA is enough

Detailed Answer:
Hello

Thanks for getting back. DMSA test is enough to note scars in the kidney.
Usually mild form of PUJ tends to resolve as the child grows older however in others surgical correction will be required by the age of 2, it is done by urologists.
For now it is best that the child is on trimethoprim to prevent UTI, you can always get back to me with the DMSA scan. CT scan is not required at the moment if DMSA has been planned.

Regards

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Yogesh D