Urinary tract infection (pediatrics) Quiz: Ace Your Exams
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A 2-year-old boy presents to the emergency department for evaluation of fever and increased irritability for the past two days. His parent reports that he has had foul-smelling, dark urine. The patient has not had a cough, congestion, sore throat, or ear ache. He is otherwise healthy and does not take any medication. He was born at 35 weeks gestation. Family history is notable for type 2 diabetes mellitus complicated by chronic kidney disease and hypertension in the patient's mother. Temperature is 38.3°C (101°F), pulse is 140/min, respiratory rate is 30/min, blood pressure is 95/60 mmHg, and oxygen saturation is 99% on room air. On physical examination, the patient appears irritable and has suprapubic tenderness to palpation. Genitourinary examination shows uncircumcised male genitalia and a normal testicular examination. Cardiopulmonary examination is within normal limits. Urinalysis findings are shown below. Which of the following factors places the patient at the highest risk of developing the likely underlying condition?
| Laboratory value | Result |
| Urinalysis | |
| Color | Clear |
| Specific gravity | 1.013 |
| Glucose | negative |
| Blood | negative |
| Leukocyte esterase | Large |
| Nitrites | Positive |
| Leukocytes | 50-100/hpf |
| Erythrocytes | 1-2/hpf |
| Dysmorphic RBCs | Absent |
| Casts | none |
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