Role of Imaging Modalities in the Management of Urinary Tract Infection in Children

  • M S Vinodkumar Government Medical College, Kozhikode, Kerala, India,
  • M Vishnu Mohan Malabar Medical College, Atholi, Kozhikode, Kerala, India
Keywords: Bacteriuria and children, Renal ultrasound, Urinary tract infection, Voiding cystourethrography

Abstract

Background: Urinary tract infections (UTIs) are a common clinical condition in pediatric practice requiring special attention as congenital
anomalies of kidneys and collecting system is usually the causes of recurrence. American Academy of Pediatrics recommends children
with UTI should be investigated with voiding cystourethrogram (VCUG), ultrasonogram of urinary tract (renal ultrasound [RUS]), and
radionuclide imaging of kidney (dimercaptosuccinic acid renal scan) for diagnosing underlying urinary tract abnormalities.
Aim of the study: The aim of the study was to assess the role of routine RUS in the management of young children hospitalized
with uncomplicated febrile UTI.
Materials and Methods: A total of 120 children between 1 month and 12 years of age with the first episode of a confirmed
diagnosis of UTI were included in this prospective cross-sectional study. All the children were thoroughly investigated after
elicitation of history. Culture of urine, ultrasonogram (RUS) and radionuclide renal scan were obtained at the time of admission.
VCUG was performed after 6 weeks to look for vesicoureteric reflux. These tests are in addition to routine investigations before
and during follow-up of treatment.
Observations and Results: RUS was done in 120 cases, and 14 (11.66%) cases had abnormal findings. Hydroureteronephrosis
is seen in 8 cases (7%), cystitis in 4 cases (3%), pelvic-ureteric junction obstruction in 2 cases (1.8%). VCUG was done in 40 cases
(31 males and 9 females) and was abnormal in 12 (30%) cases. 4 (10%) and 2 (5%) of 40 cases had Grades 1–2 vesicoureteral
reflux (VUR) and Grades 3–4 VUR, respectively. 4 (13%) of 31 males and 2(22%) of 9 females who underwent VCUG had
evidence of VUR; this female to male ratio of 1.7:1 found was not significant statistically (P = 0.49). The sensitivity, specificity,
positive predictive value, and negative predictive value of RUS for detecting VUR were 20.7%, 87.33%, 26.33%, and 83.33%,
respectively [Table 1]. For the purpose of further analysis, the children were divided into three age groups: <1 year (28 children
and 20/08 male/female), 1–5 years (60 children and 44/16 male/female), and 5–12 years (32 children and 12/20 male/female).
Conclusions: The present study question the yield of routine RUS in the management of young children with simple UTI. The study
concludes that RUS should only be performed in children in whom complications such as renal obstruction or abscess are suspected
based on an unfavorable clinical course, or in children in whom VUR has been found, to look for renal structure abnormalities.
Key words: , , , 

Author Biographies

M S Vinodkumar, Government Medical College, Kozhikode, Kerala, India,

Assistant Professor, Department of Paediatrics,

M Vishnu Mohan, Malabar Medical College, Atholi, Kozhikode, Kerala, India

Assistant Professor of Paediatrics,

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Published
2018-06-15