Urinary tract infection in childhood. Review of guidelines and recommendations.

Children with urinary tract infection continue to be an important part of the pediatric practice. New uroradiologic imaging techniques like cortical radionuclide scanning and prenatal ultrasonography improved our understanding of the etiology, effect of treatment and outcome of these patients. Evidently, most kidneys at risk are those which already sustained intrauterine damage by obstruction or vesicoureteral reflux. It is the pediatrician's role to minimize ex-utero damage caused by bacterial infection by early diagnosis and appropriate intervention. The introduction of new potent oral antimicrobials limits the need for hospitalization only to the very young infant and the very seriously ill child. Whereas the roles of routine renal ultrasound and cortical radionuclide scan are debatable, all young children and select older children have to be investigated by cystography for possible vesicoureteral reflux. In children with vesicoureteral reflux, long-term antibiotic prophylaxis is required in most children but in a few surgical correction might be indicated. Young siblings of the propositus with vesicoureteral reflux have to be investigated as well for possible reflux. This review covers these and other guidelines and recommendations of diagnosis and treatment of UTI in children at the beginning of the third millennium.

Antacid-induced rickets in infancy.

A 3-month-old premature infant presented with a "soft skull." Clinical and radiologic findings confirmed the diagnosis of rickets. Biochemistry revealed normal serum parathyroid hormone (PTH) and undetectable urine phosphate. These findings combined with a history of 5-6 weeks' treatment with high-dose aluminum-rich antacid established the diagnosis of antacid-induced rickets. Discontinuation of the medicine combined with phosphate and vitamin D supplementation resulted in quick resolution of all clinical, radiologic, and biochemical abnormalities. Our patient demonstrates that in premature infants antacid-induced rickets can develop within a few weeks; normal serum PTH concentration and hypophosphaturia are highly indicative of the diagnosis, and contrary to the situation in adults in whom hypercalciuria has been often described, in infants hypocalciuria is more commonly observed. Pediatricians should avoid or minimize the use of aluminum-containing antacids, and when used, carefully monitor mineral metabolism.