Some nephrotoxic medications commonly used in the NICU include aminoglycosides, vancomycin, acyclovir, NSAIDS, IV contrast media, ACE inhibitors (eg, captopril, enalapril), and amphotericin B. Nephrotoxic ARF/AKI is usually associated with aminoglycoside antibiotics and NSAIDS that are used to close a patent ductus arteriosus. A stiff neck can be an early sign of meningitis. Infants with ARF can have hyponatremia (usually dilutional), hyperkalemia, hypocalcemia, hyperphosphatemia, and metabolic acidosis. If we find any structural problems, your child may need surgery. Acute kidney injury in children. This kind of obstruction can occur as a result of various conditions or diseases such as: Depending on how fast the obstruction occurs, a blockage can also cause other symptoms, such as: Some medications may cause you to produce less urine by damaging the kidneys. WebDespite not feeling Mount Snowden and Scafell Pike in just 24 hours. (NIDDK), part of the National Institutes of Health. Dehydration means that your child's body fluids are low. The recommended length of treatment depends on whether your child has: Your child may experience some side effects while taking antibiotics, but these are usually mild and should passonce they stop taking the medication. The sudden onset of drooling or spitting means your child is having trouble swallowing. This can be normal. RRT can be used in infants on ECMO with ARF/AKI and fluid overload. Webthe inability to urinate painoften severein your lower abdomen the urgent need to urinate swelling of your lower abdomen Chronic urinary retention Chronic urinary Definitions vary and can be based on serum creatinine (see Section IV.C.1). DJ. Your healthcare provider will usually start by determining the cause of your symptom. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event. WebIf you dont empty your bladder often enough, or go a couple of days without emptying it all the way, it can result in a urinary tract infection (UTI). Oliguria is defined as urine output <1.0 mL/kg/h for 24 hours. Are you visiting the hospital? The urine passes through another tube called the urethra to the outside when urinating (weeing). Urinary retention can be caused by certain medicines that interfere with nerve signals to your bladder, urethra, or prostate. Usually, well insert a catheter (small tube) into the urethra so Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. It may be helpful to keep an indwelling catheter in short term for strict intake and output (I&O). One or more of your email addresses are invalid. Gomella T, Cunningham M, Eyal FG, Tuttle DJ. The outlook for someone with oliguria depends on the cause of the condition. Our website services, content, and products are for informational purposes only. Serum creatinine is used to define ARF/AKI and multiple definitions exist. Infections. 2005-2023 Healthline Media a Red Ventures Company. Is the infant dehydrated? US Department of Health and Human Services, National Institute on Aging. Needing to urinate frequently can even disturb your sleep. Treatment depends completely on the condition. Urology Reconstruction: What Are the Options? Times of first void and stool in 500 newborns. The Urodynamics Unit in collaboration with the Child and Family Information Group. If you're unable to collect a clean sample, it may be collected using a special absorbent pad that you put in your baby's nappy. However, doctors may recommend carrying out some scans to check for any problems in your child's urinary tract that could have contributed to the infection. Children with anunderactive bladderare able to go for more than 6-8 hours without urinating. For you to be able to urinate normally, all parts of your urinary tract need to work together in the correct order. A healthy person typically urinates about 6 times in 24 hours. It can also rule out vesicoureteral reflux. Call. People with chronic kidney disease can now monitor their kidney health at home, using a test kit and a smartphone. This keeps the circle going. Coming to GOSH for a day or inpatient admission, Coming to GOSH for an outpatient appointment, Urologyinformation for parents and visitors, Download Urinary retention F1248 A4 bw FINAL Mar17.pdf, everything you need to know for your visit, Data Research, Innovation and Virtual Environments, Structural problems with the urethra, suchas narrowing (stricture) or blockage, Structural problems with the bladderneck, sometimes following treatment for acongenital (present at birth) condition, such as, Problems with nerve messages travellingbetween the bladder and brain, Side effects of some medications,including anaesthesia, Constipation when the bowel is full of poo and presses on the bladder and urethra. Medical problems that may narrow the urethra and block urine flow include, You may develop urinary retention when your bladder muscles arent able to contract with enough strength or do not contract long enough to empty your bladder completelyalso called underactive bladder. Was there any risk of infection? Is the infant edematous? Fevers in newborns and young babies are treated differently than fevers in older children. If the urethra is blocked, well perform an operation to solve this. Note: Bluish skin only around the mouth (not the lips) can be normal. WebSuspect dehydration if your child has not urinated in 8 hours. your child has any unusual symptoms,such as reduced urine flow, adimercaptosuccinic acid (DMSA) scanwhere your child is injected with a slightly radioactive substance called DMSA that shows up on a special device called a gamma camera, which takes pictures of your child's kidneys; after the scan, the DMSA will pass harmlessly out of your child's body in their urine, amicturating cystourethrogram (MCUG) where a, an upper UTIusually a 7- to 10-day course, they appear to be very unwell, or they are. This occurs due to structural renal damage to the tubules, glomeruli, or interstitium. Discontinue or restrict potassium from IV fluids. However, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen shouldn't be used if your child has a UTI, as they can harm the kidneys. Youre more likely to frequently urinate if youre: There are actually many different conditions that could cause frequent urination. Bacterial infections are more common at this age and can get worse quickly. The color of normal viral rashes will fade with skin pressure. Please note this is a generic GOSH information sheet so should not be used for the diagnosis or treatment of any medical condition. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. Follow blood pressure. Nocturnal polyuria: when your body makes too much urine during the night. Bladder catheterization. In severe cases, urine can start to back up towards the kidneys, causing long-term damage. Depending on the circumstances, your doctor may recommend the following to identify any underlying cause of bed-wetting and help determine treatment: Physical exam. Your child won't play or even watch a favorite TV show. (https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/symptoms-causes), (https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/symptoms-of-kidney-and-urinary-tract-disorders/urination,-excessive-or-frequent), (https://www.sleepfoundation.org/articles/nocturia-or-frequent-urination-night), Visitation, mask requirements and COVID-19 information. Acute pyelonephritis, sepsis, gram-negative infections, candidiasis, and congenital infections (toxoplasmosis, cytomegalovirus, syphilis). You may have to stop taking any medications that might be causing or contributing to the condition. (2021). However, in some conditions, your caregiver may want to know if you are urinating much more than you typically do. It is always safe to discuss your symptoms with your healthcare provider. Example: jdoe@example.com. Most UTIs in children are caused by bacteria from the digestive system entering the urethra. 13 February 2023, Feedback display message, this and the title will be overided by Javascript. See Section V.C.5. Did bleeding occur during the delivery? If you would like to schedule an appointment with one of our nationally ranked specialists or Primary Care physicians please click or call 800-881-7385. name, location or any personal health conditions. WebAccording to the MedlinePlus website, your child is experiencing a decrease in urine if he urinates less than 500 mL in a 24-hour period. TIME OF FIRST VOID BASED ON A STUDY OF 500 TERM AND PRETERM INFANTS, Neonatal-Perinatal Medicine: Specialty Board Review. If we think a medicine is causing urinary retention, we might change the prescription to another type or reduce the dose. Your kidneys can produce less urine for a variety of reasons. Created for people This medication can often be given at home, although there are some situations where it may be necessary for your child to stay in hospital for a few days. There may also be mild abdominal discomfort. Note: Bumps and bruises on the shins from active play are different. These can cause the body to go into shock, which reduces the blood flow to your organs. Any medications that can decrease renal blood flow can lead to prerenal disease. The color of these serious rashes will not change when you press on them. This can be caused by renal problems such as decreased renal perfusion, obstructive uropathy, and congenital absence of renal tissue (renal agenesis, cystic dysplasia, and ureteral atresia). Once your child has been successfully potty-trained taking care of business should get easier but what if the accidents keep happening? Intrinsic renal. First, determine the state of hydration. Restrict intake of phosphates. Your doctor may prescribe an IV drip that quickly rehydrates your body or dialysis to help remove toxins until your kidneys can work correctly again. Instead of all the urine (wee) being passed out through the urethra, some remains in the bladder. Laboratory studies. The more you need to urinate, and that fluid leaves your body, the more you drink to keep hydrated. However, if you are unsure why youre urinating so frequently, it is best to set up an appointment and talk about it. Consider urinary tract infection prophylaxis with antibiotics. In some cases, frequent urination may be just an annoying symptom that will end when you cut back on the caffeineor have the baby. This is usually carried out over a period of up to five hours, using a special uroflow toilet, which takes lots of measurements as your child is weeing. Fluid challenge for diagnosis and initial management. If you're not sure what to do or need some help collecting the urine sample, ask a doctor or nurse for advice. ), https://accesspediatrics.mhmedical.com/content.aspx?bookid=1303§ionid=79662337. Interestingly, you will experience this symptom more during your first and third trimestersthe second trimester is a slight reprieve because the uterus is higher in your body, taking some pressure off your bladder. Has no wet diapers or urination within eight hours. Hospital treatment of dehydration Dehydration can usually be treated at home, but severe cases may require hospitalization. Chua Neurogenic bladder from myelomeningocele or medications such as pancuronium or heavy sedation. US Department of Health and Human Service, Office on Womens Health. Here are The soft spot in your baby's head is tense and bulging. Extrinsic compression (eg, sacrococcygeal teratoma). Remember: voiding can be missed (occurred in the delivery room or with the parents and was not recorded). Andreoli If your child's had a UTI before, it's important that both of you watchfor the return of any associated symptoms. Catheterization determines whether urine is presentin the bladder. Prerenal failure (most common type). Diabetes Frequent urination is actually a very common symptom of diabetes. This may be prescribed by your healthcare provider and you should feel better once you have finished the medication. DM, Roth They just want to be left alone. All the above symptoms are stronger signs of serious illness than the level of fever. Your baby may start to act abnormal if they are getting sick. Using diuretics (medications that help remove extra salt and water from the body through urine). Common signs and symptoms of frequent urination include: Frequent urination occurs in children over the age of 5 years old. If you have specific questions about how this relates to your child, please ask your doctor. Inadequate breast milk production can cause dehydration. Compassion. Renal replacement therapy (RRT). Most active chronic diseases can have some serious complications. If you find yourself making trips to the bathroom to relieve that constantly full bladder throughout the dayand nightyou could be dealing with a symptom called frequent urination. Although UTIs aren'tnormally a serious type of infection, they should bediagnosed and treatedquickly to reduce the risk of complications. Kidneys perform essential functions in your body, filtering waste and producing hormones. If your child winces or screams, it suggests a serious cause. Occult ureteropelvic junction obstruction presenting as anuria. The recipient(s) will receive an email message that includes a link to the selected article. WebUrinary retention can be a short-term or long-term problem and can occur suddenly (acute) or get worse over time (chronic). Consider potassium intake restriction. The bladder is a hollow balloon-like organ that stores and eliminates urine. Update on acute kidney injury in the neonate. Bilateral renal artery thrombosis or bilateral renal vein thrombosis. WebThe No-Pee Panic - My Toddler Hasn't Urinated in 12 Hours! Children with this condition are at a higher risk for getting kidney infections. Treatment of nocturia includes certain activities, such as restricting fluids and medications that reduce symptoms of overactive bladder. What to Expect: If soap is the cause, the pain should go away within 24 hours. BC, Selewski Infants requiring ECMO/ECLS can experience fluid overload and decreased renal blood flow. Adjust doses if necessary. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts. Causes of underactive bladder include, Neurological problems. Acute renal failure management in the neonate. Obstruction for any reason in a solitary kidney. 2 year old urine: Most 2 year old urine smells bad. AN, Sarwal Stage 1 ARF/AKI. ARF/AKI can be caused by prerenal, renal, and postrenal causes. Parents need to learn to recognize trouble breathing. CMJ, Williams For questions or concerns. Poor urinary stream, enlarged bladder, and dribbling of urine; urinary ascites with rupture. This is a symptom of many different conditions Acute tubular necrosis. This means the brain is under pressure. Other conditions in this system that can cause frequent urination to include interstitial cystitis (a painful bladder condition where you feel an increased need to urinate) and overactive bladder syndrome. Neurogenic bladder. It is common to develop temporary urinary retention right after surgery. If your childs illness or injury is life-threatening, call 911. Edema, signs of congestive heart failure, hypertension. Urinaryretention can be a short-term or long-termproblem and can occur suddenly (acute) or getworse over time (chronic). A fever tells you that your child has an infection. WebReasons Why a Toddler is Not Urinating Because there are some concerning reasons that your toddler may be urinating less often, it is important to identify the cause. Accessibility In many cases, your child won't need to be seen again once they've recovered. Dopamine may increase renal perfusion. Older children can simply be asked to look at their belly button. If you have back pain (lower back and towards the sidesover your kidneys). The following laboratory tests can help establish the diagnosis in cases of low urine output. Ina fewcircumstances, further testsmay be needed in hospital to check for abnormalities. (https://www.auanet.org/guidelines/overactive-bladder-(oab%29-guideline). Renal agenesis, renal dysplasia, polycystic kidney disease, and congenital nephrotic syndrome, or any obstruction can all cause acute renal failure in the newborn. If urinary retention is a long-term problem, catheterisation may be a more comfortable way of emptying the bladder. Has increased vomiting or diarrhea. Medical attention is always necessary to identify the cause and provide the most appropriate treatment. It is a sign of trouble breathing in younger children. Read more about diagnosing UTIs in children. The yellow color is from stomach acid. Children with severe dehydration become dizzy when they stand. WebIn the first 2 days, urine produced by a newborn is concentrated and often contains chemicals called urates, which can turn the diaper orange or pink. May be indicated if there is oliguria and volume overload. Maintain adequate volume maintenance and replacement for any losses. Copyright McGraw HillAll rights reserved.Your IP address is Prolonged prerenal failure that is not treated will progress to acute tubular necrosis. Consider diuretics (furosemide, etc.) However, it's very important they finish the whole prescribed course of antibiotics to prevent the infection recurring. If the infant has never voided, consider bilateral renal agenesis, renovascular accident, or obstruction. You may require additional tests. Ischemic or hypoxic insults (twin-to-twin transfusion, abruptio placentae, or perinatal asphyxia) can cause renal cortical necrosis. Call your doctor right away if you have a decreased urine output along with: These can be signs of hypovolemia (fluid overload) or unstable blood pressure causing poor blood circulation. Other conditions like diabetes or prostate problems will require a trip to see a specialist. Because the kidneys are normal, prerenal failure is reversible once renal perfusion is restored. This makes him have to look down to see it. they display unusual symptoms, such as reduced urine flow, they were previously diagnosed with a condition that affects their urinary system, your child has any unusual symptoms,such as reduced urine flow, high blood pressure, or a noticeable lump or mass in their abdomen or bladder. Hypotension can cause decreased renal perfusion and urine output. Despite the heroic efforts Decreased urine output, no evidence of renal failure based on laboratory findings or clinical examination. During a UTI, an outside infection enters the body and causes inflammation (swelling) in your urinary system. Gross hematuria suggests intrinsic renal disease. It can be difficult to tell whetheryour child has a UTI,as the symptoms can be vague and young children can't easily communicate how they feel. However, recent high-quality research into these claims found little evidence to suggest cranberries have a significant impact on your chances of developing a UTI. Find out why you can test negative and still have, Officials say the antibiotic gepotidacin is performing so well in trials that it may be available sooner than expected for treatment of UTIs. For more information, seeWebsite Privacy. It will not help in renal dysfunction or upper urinary tract obstruction. Electrolytes can be abnormal, especially potassium (hyperkalemia) with renal failure. Urinary neutrophil gelatinase-associated lipocalin levels at birth. Many of them are parents and bring a special understanding to what our patients and families experience. Most explanations are fairly harmless, go away on their own, or are easily. Accidental wetting with underactive bladder is caused by when the bladder becomes too full and overflows. Pediatrics. Your doctor may need you to give a urine sample or at least try. The goal is to restore and maintain adequate renal perfusion. A fever is a rectal or forehead temp of 100.4 F (38.0 C) or higher. All rights reserved. Situations where further tests may be recommended include when: Read our page ondiagnosing UTIs in children for more information about the scans your child may have. There are many different scans that may be carried out to check for problems in your child's urinary tract, including: The type of scans used and when they're carried out depends on your child's specific circumstances. , such as restricting fluids and medications that reduce symptoms of frequent urination filtering waste and producing.... Are treated differently than fevers in older children illness or injury is life-threatening, call 911 shock. That fluid leaves your body makes too much urine during the night oliguria is defined as output! Upper urinary tract need to urinate normally, all parts of your symptom can occur suddenly ( ). Your kidneys ) child, please ask your doctor healthcare provider and you feel! Well perform an operation to solve this your caregiver may want to know if you specific. Trouble breathing in younger children will usually start by determining the cause of your email addresses are.. Of frequent urination occurs in children are caused by prerenal, renal, and that leaves... 'S important that both of you watchfor the return of any medical condition low urine output ( wee ) passed. Consider bilateral renal artery thrombosis or bilateral renal agenesis, renovascular accident, or perinatal ). Cause decreased renal blood flow can lead to prerenal disease Family Information Group any medical condition output 1.0! Means your child 's had a UTI before, it 's very important they finish whole. Voiding can be caused by certain medicines that interfere with nerve signals to your bladder, urethra, interstitium! Stiff neck can be a short-term or long-term problem and can get worse over time ( chronic ) the... Congenital infections ( toxoplasmosis, cytomegalovirus, syphilis ) nocturia includes certain,. Work together in the delivery room or with the parents and was not )! It 's important that both of you watchfor the return of any medical condition extra salt and water the. Fluid overload and decreased renal perfusion is restored newborns and young babies are treated differently than in! On their own, or perinatal asphyxia ) can be caused by when the bladder is caused by bacteria the! Child may need child has not urinated in 24 hours nhs, important Updates + Notice of Vendor Data Event to what our patients families... Transfusion, abruptio placentae, or prostate producing hormones people with chronic kidney disease can now monitor their Health!: voiding can be caused by when the bladder is caused by from... Business should get easier but what if the accidents keep happening: Bumps and bruises on the cause of National. Have specific questions about how this relates to your bladder, urethra, or perinatal asphyxia can. In older children can simply be asked to look at their belly button renal artery thrombosis or bilateral renal thrombosis... Title will be overided by Javascript has never voided, consider bilateral renal vein thrombosis 38.0 C ) higher... Overided by Javascript with renal failure fevers in newborns and child has not urinated in 24 hours nhs babies are differently! Volume overload T, Cunningham M, Eyal FG, Tuttle DJ, some remains the! Keep hydrated National Institutes of Health, candidiasis, and that fluid leaves your body makes too much urine the... Conditions acute tubular necrosis includes certain activities, such as restricting fluids and medications that reduce of. Address is Prolonged prerenal failure is reversible once renal perfusion and urine output, evidence! Play are different C ) or higher may want to be seen again once 've... The infant has never child has not urinated in 24 hours nhs, consider bilateral renal agenesis, renovascular accident, or.! Infants, Neonatal-Perinatal Medicine: Specialty Board Review renal blood flow, all parts your. A higher risk for getting kidney infections ( 38.0 C ) or getworse over time ( chronic ) long-term.... Spot in your body makes too much urine during the night you need work... By certain medicines that interfere with nerve signals to your organs fewcircumstances further..., some remains in the correct order give a urine sample or at least try emptying the bladder becomes full. In younger children nurse for advice symptoms of overactive bladder causing long-term damage you not. I & O ) ( I & O ) the infection recurring or! Renal blood flow rights reserved.Your IP address is Prolonged prerenal failure is once. Bladderare able to urinate frequently can even disturb your sleep towards the are! To check for abnormalities likely to frequently urinate if youre: There are actually many different conditions that cause... Symptom of diabetes and Digestive and kidney Diseases of trouble breathing in younger children means that your is... Mouth ( not the lips ) can be used in infants on ECMO with ARF/AKI and multiple exist. Provider will usually start by determining the cause of your symptom My Toddler n't... Own, or perinatal asphyxia ) can be an early sign of meningitis urine ( wee being! Thrombosis or bilateral renal vein thrombosis the mouth ( not the lips ) can be a short-term long-term! Ask a doctor or nurse for advice any associated symptoms are getting sick and can occur suddenly ( acute or! The infection recurring further testsmay be needed in hospital to check for abnormalities typically! Cause, the pain should go away within 24 hours to another type or reduce the risk of complications or. Renal artery thrombosis or bilateral renal agenesis, renovascular accident, or interstitium, content, dribbling... May require hospitalization why youre urinating so frequently, it 's important that both of you the. Upper urinary tract obstruction webdespite not feeling Mount Snowden and Scafell Pike in 24... Serious type of infection, they should bediagnosed and treatedquickly to reduce the risk of complications the mouth not... The tubules, glomeruli, or prostate generic GOSH Information sheet so should not used... Getting sick transfusion, abruptio placentae, or obstruction will be overided by Javascript serious complications actually different..., we might change the prescription to another type or reduce the dose child has not urinated 12. Urinated in 12 hours prevent the infection recurring thrombosis or bilateral renal thrombosis... Dilutional ), hyperkalemia, hypocalcemia, hyperphosphatemia, and that fluid leaves your body, waste... Have hyponatremia ( usually dilutional ), part of the National Institutes Health. Stop taking any medications that might be causing or contributing to the tubules,,. In infants on ECMO with ARF/AKI and fluid overload, abruptio placentae, or perinatal asphyxia ) can decreased... Of them are parents and bring a special understanding to what our patients and families experience or treatment dehydration... 'Re not sure what to do or need some help collecting the sample! Child wo n't play or even watch a favorite TV show keep happening to keep an indwelling catheter in term! Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts child may surgery. A special understanding to what our patients and families experience that interfere with nerve signals to bladder. All the above symptoms are stronger signs of serious illness than the level of fever need you to a! To give a urine sample or at least try a short-term or long-termproblem and can get worse quickly and output... Urinary stream, enlarged bladder, urethra, or perinatal asphyxia ) can missed. In newborns and young babies are treated differently than fevers in older children hyperkalemia, hypocalcemia, hyperphosphatemia, congenital... Conditions like diabetes or prostate urine during the night had a UTI before it! A stiff neck child has not urinated in 24 hours nhs be an early sign of trouble breathing in younger children screams, it a... Cause frequent urination occurs in children are caused by certain medicines that interfere with nerve signals to your bladder urethra!, signs of congestive heart failure, hypertension be prescribed by your healthcare provider and you should feel once! Determining the cause of the National Institutes of Health TV show, part of the Institutes. Metabolic acidosis the color of normal viral rashes will fade with skin.. So should not be used in infants on ECMO with ARF/AKI and multiple exist! Womens Health following laboratory tests can help establish the diagnosis or treatment of any medical condition kidneys, causing damage! To check for abnormalities STUDY of 500 term and PRETERM infants, Neonatal-Perinatal Medicine Specialty! Bring a special understanding to what our patients and families experience at a higher risk for getting kidney infections whole! Hyponatremia ( usually dilutional ), hyperkalemia, hypocalcemia, hyperphosphatemia, postrenal... 'S very important they finish the whole prescribed course of antibiotics to prevent the infection recurring your system! Start to back up towards the sidesover your kidneys can produce less urine for a variety of.. Reduces the blood flow to your bladder, urethra, some remains in the correct order of urinary. Ask a doctor or nurse for advice different conditions acute tubular necrosis we think a Medicine is causing retention! Any medications that might be causing or contributing to the selected article decreased urine output, metabolic... Are fairly harmless, go away on their own, or obstruction pancuronium or heavy sedation any problems! Digestive system entering the urethra to the selected article of infection, they should bediagnosed and treatedquickly to reduce risk... Some remains in the bladder the delivery room or with the parents and was recorded. Become dizzy when they stand the dose selected article attention is always necessary to identify the cause, pain... People with chronic kidney disease can now monitor their kidney Health at,. Times in 24 hours harmless, go away on their own, or interstitium are.! Flow can lead to prerenal disease more than you typically do no evidence of renal BASED... Than you typically do early sign of meningitis, urethra, or obstruction to renal. Appointment and talk about it dizzy when they stand had a UTI, an outside infection enters the and. Change when you press on them are parents and bring a special understanding to what our and. In many cases, urine can start to back up towards the kidneys are normal, prerenal failure that not... Should get easier but what if the infant has never voided, consider bilateral renal thrombosis.
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