>Is there any evidence on babies? Young children are surely the most
>difficult category of ?UTI - the most difficult to get samples from
>but the most important to diagnose. I confess I use Nephur test sticks
>on wet nappies but I don't know if this is a valid thing to do?
Probably not
There was a paper from the baby/child kidney folk in Newcastle a year or
so ago looking at dip testing urine using the newer sticks. (Sorry don't
have the reference to hand) My recollection is that the problem is
two-fold - a) The nitrite load in a small sample is low enough to be
missed by the sticks (increasing the false -ves) and b) feverish children
often put out wbcs in their urine which are detected by the sticks
(increasing the false +ves). Conclusion - unacceptable sensitivity /
specificity.
The solution? - collect urine on a pad in the nappy (old non-super
absorbent sanitary pad, now stocked by NHS supplies for this purpose).
Place pad in syringe and squeeze into sample bottle (don't use boric acid
unless there is enough urine to fill to the line).
The secret at this point is to put a drop on a microscope slide and look
at it down a microscope! If you see bugs then send the urine to the lab,
start antibiotics and refer for investigation. If you don't see bugs, bin
the sample, (and save money). The is good evidence that even trained
monkeys (SHOs) can reliably diagnose UTIs using this method (personal
experience and published work).
Other half remembered points -
Diagnosis rate of children's UTI is about 7% in UK and 12-14% in
Scandinavia.
Maybe around 40% of transplants are done for renal damage sustained in
childhood.
Phase contrast microscope around 5000 ukp - 'but to you my son' 700 ukp
if purchased from a contact of above nephrologists - also great for
scabies mites!
--
Mike Prentice
GP Career Start, Co Durham
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