DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20171074

Role of imaging in children with urinary tract infections

Subash Sundar, Balaji Chinnasami, Kanimozhi Sadasivam, Sekar Pasupathy

Abstract


Background: As per recommendation from the American Academy of pediatrics a child with first episode of urinary tract infection should be evaluated for underlying urinary tract abnormalities by undergoing voiding cystourethrogram, ultrasonogram of urinary tract and radionuclide imaging of kidney. We studied role of these imaging studies in picking up renal abnormalities.

Methods: We conducted a descriptive study in which 100 children aged 1mth-12 years with documented urinary tract infection (UTI) were included. Ultrasonogram (USG) and radionuclide renal scan were obtained at the time of admission. Voiding cystourethrography (VCUG) was performed after 6weeks to look for vesicoureteric reflux.

Results: Forty three children underwent both DMSA and follow up VCUG. Ultrasonogram picked up acute pyelonephritis (APN) in 7.1% of children with UTI while 31.1% had pyelonephritis on DMSA. Overall incidence of VUR was 16.3%. The sensitivity of USG for VUR detection was only 14.2%. The sensitivity of USG as a screening test for APN is 7%.

Conclusions: All children less than five years with UTI must undergo DMSA and VCUG. Ultrasonography is less sensitive in detecting VUR and acute pyelonephritis.


Keywords


Acute pyelonephritis, Dimercaptosuccinic acid, Vesicoureteric reflux, Voiding cystourethrogram, Ultrasonogram

Full Text:

PDF

References


Sherbotie JR, Cornfeld D. Management of urinary tract infections in children. Med Clin North Am. 1991;75(2):327-38.

Williams G, Lee A, Craig J. Antibiotics for the prevention of urinary tract infection in children: a systematic review of randomized controlled trials. J. Pediatr. 2001;138(6):868-74.

Roberts, Kenneth B. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. 2011:595-610.

Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008;27(4):302-8.

Das RN, Chandrashekhar TS, Joshi HS, Gurung M, Shrestha N, Shivananda PG. Frequency and susceptibility profile of pathogens causing urinary tract infections at a tertiary care hospital in western Nepal. Singapore Med J. 2006;47(4):281.

Winberg J, Andersen HJ, Bergström T, Jacobsson B, Larson H, Lincoln K. Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatrica. 1974;63(S252):1-20.

Benador D, Benador N, Slosman DO, Nusslé D, Mermillod B and Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J. Pediatr. 1994:124(1);17-20.

Kass EJ, Kernen KM, Carey JM. Paediatric urinary tract infection and the necessity of complete urological imaging. BJU international. 2000;86(1):94-6.

Howard RG, Roebuck DJ, Au Yeung P, Chan KW, Metreweli C. Vesicoureteric reflux and renal scarring in Chinese children. Br J Radiol. 2001;74(880):331-4.

Jothilakshmi K, Vijayaraghavan B, Paul S, Matthai J. Radiological evaluation of the urinary tract in children with urinary infection. Indian J Pediatr. 2001;68(12):1131-33.

Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med. 2003;348(3):195-202.

Williams G, Fletcher JT, Alexander SI and Craig JC. Vesicoureteral reflux. Clin J Am Soc Nephrol. 2008:19(5);847-62.

Connolly LP, Treves ST, Connolly SA, Zurakowski D, Share JC, Bar-Sever Z, et al. Vesicoureteral reflux in children: incidence and severity in siblings. J. Urol. 1997;157(6):2287-90.

Rushton HG, Majd MA, Jantausch B, Wiedermann BL, Belman AB. Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99 mtechnetium- dimercaptosuccinic acid scintigraphy. J. Urol. 1992;147(5):1327-32.

Christian MT, McColl JH, MacKenzie JR, Beattie TJ. Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography. Arch. Dis. Child. 2000;82(5):376-80.

DiPietro MA, Blane CE, Zerin JM. Vesicoureteral reflux in older children: concordance of US and voiding cystourethrographic findings. Radiology. 1997;205(3):821-2.

Mahant S, Friedman J, MacArthur C. Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection. Arch. Dis. Child. 2002;86(6):419-20.