Role of Imaging Modalities in the Management of Urinary Tract Infection in Children
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: , , ,
Subcommittee on Urinary Tract Infection. Practice Parameter: The
diagnosis, treatment, and evaluation of the initial urinary tract infection in
febrile infants and young children. Pediatrics 1999;103:843-52.
2. Jodal U, Lindberg U. Guidelines for management of children with urinary
tract infection and vesico-ureteric reflux. Recommendations from a
Swedish state of- the-art conference. Swedish Medical Research Council.
Acta Paediatr Suppl 1999;88:87-9.
3. Leoniads JC, McCauley RG, Klauber GC. Sonography as a substitute
for excretory urography in children with urinary tract infections. Am J
4. Mason WG. Urinary tract infection in children: Renal ultrasound evaluation.
5. Mucci B, Maguire B. Does routine ultrasound have a role in the investigation
of children with urinary tract infection? Clin Radiol 1994;49:324-5.
6. Hoberman A, Wald E. Urinary tract infections in young febrile children.
Pediatr Infect Dis J 1997;16:11-7.
7. Alon US, Ganapathy S. Should renal ultrasonography be done routinely inchildren with first urinary tract infection? Clin Pediatr 1999;38:21-5.
8. Alon US. More on urinary tract infection guidelines. Pediatrics
9. Mittelstaedt CA, Vincent LM. Abdominal Ultrasound. New York: Churchill
Livingstone; 1987. p. 252.
10. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, TamminenMöbius TE. International system of radiographic grading of vesicoureteric
reflux. international reflux study in children. Pediatr Radiol 1985;15:105-9.
11. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract
infection in childhood: A meta-analysis. Pediatr Infect Dis J 2008;27:302-8.
12. Mahant S, Friedman J, MacArthur C. Renal ultrasound findings and
vesicoureteral reflux in children hospitalized with urinary tract infection.
Arch Dis Child 2002;86:419-20.13. Kass EJ, Kernen KM, Carey JM. Paediatric urinary tract infection and the
necessity of complete urological imaging. BJU Int 2000;86:94-6.
14. Di Pietro MA, Blane CE, Zerin JM. Vesicoureteral reflux in older children:
Concordance of US and voiding cystourethrographic findings. Radiology
15. Smellie JM, Rigden SP, Prescod NP. Urinary tract infection: A comparison
of four methods of investigation. Arch Dis Child 1995;72:247-50.
16. Goldman M, Lahat E, Strauss GR, Reisler G, Livne A, Gordin L, et al.
Imaging after urinary tract infection in male neonates. Pediatrics
17. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER,
et al. Imaging studies after a first febrile urinary tract infection in young
children. N Engl J Med 2003;348:195-202