SOAP Note

S - 6 years old presents with dysuria and urinary frequencies x 3 days O - Urinalysis shows blood trace, protein 30, leukocytes esterase moderate, WBC >50, bacteria many A - The patient's symptoms and urinalysis results suggest a urinary tract infection (UTI) P - Treatment with antibiotics and further evaluation to rule out underlying conditions

Differential Diagnosis

• Single most likely diagnosis
  • Urinary Tract Infection (UTI): The patient's symptoms of dysuria and urinary frequency, combined with the urinalysis results showing leukocytes esterase, WBC >50, and bacteria, strongly suggest a UTI.
• Other Likely diagnoses
  • Vesicoureteral Reflux (VUR): The presence of protein and blood in the urine, along with a UTI, may indicate VUR, a condition where urine flows backward from the bladder to the kidneys.
  • Kidney Stone: Although less common in children, a kidney stone could cause dysuria, frequency, and hematuria (blood in the urine).
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Sepsis: If the UTI is not promptly treated, it could lead to sepsis, a life-threatening condition.
  • Pyelonephritis: An upper urinary tract infection that can cause severe illness and long-term kidney damage if not treated promptly.
  • Post-Streptococcal Glomerulonephritis (PSGN): A rare but serious condition that can occur after a streptococcal infection, causing kidney inflammation.
• Rare diagnoses
  • Tubulointerstitial Nephritis: A rare condition characterized by inflammation of the kidney tubules and interstitium, which could cause similar symptoms.
  • Urethral Stricture: A rare condition in children, but could cause obstructive symptoms and recurrent UTIs.