Febrile Urinary Tract Infections in Infants: Renal Ultrasound Remains Necessary

Giorgi, Louis J.; Bratslavsky, Gennady; Kogan, Barry A.

doi:10.1097/01.ju.0000149826.70405.c5

Cited by 53 publications

(30 citation statements)

References 12 publications

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“…However, most of these papers have limitations that make it impossible to determine the test characteristics of RBUS; most common is that many studies do not provide sufficient data to directly compare RBUS findings with VCUG findings in individual patients. [12][13][14][15][16][17][18][19] Other studies focus on the value of RBUS to predict renal scintigraphic findings (scarring). 13,[20][21][22] Verification bias is a common weakness in the published literature.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Nelson¹,

Johnson²,

Logvinenko

et al. 2014

Pediatrics

107

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WHAT'S KNOWN ON THIS SUBJECT: Current guidelines recommend renal ultrasound as a screening test after febrile urinary tract infection, with voiding cystourethrogram (VCUG) only if the ultrasound is abnormal. Few studies have evaluated the accuracy of ultrasound as a screening test for VCUG-identified abnormalities. WHAT THIS STUDY ADDS:This study shows that ultrasound is a poor screening test for genitourinary abnormalities identified on VCUG, such as vesicoureteral reflux. Neither positive nor negative ultrasounds reliably identify or rule out such abnormalities. Ultrasound and VCUG provide different, but complementary, information.abstract BACKGROUND: The 2011 American Academy of Pediatrics guidelines state that renal and bladder ultrasound (RBUS) should be performed after initial febrile urinary tract infection (UTI) in a young child, with voiding cystourethrogram (VCUG) performed only if RBUS shows abnormalities. We sought to determine test characteristics and predictive values of RBUS for VCUG findings in this setting. METHODS:We analyzed 3995 clinical encounters from January 1, 2006 to December 31, 2010 during which VCUG and RBUS were performed for history of UTI. Patients who had previous postnatal genitourinary imaging or history of prenatal hydronephrosis were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined. RESULTS:We identified 2259 patients age ,60 months who had UTI as the indication for imaging. RBUS was reported as "normal" in 75%. On VCUG, any vesicoureteral reflux (VUR) was identified in 41.7%, VUR grade .II in 20.9%, and VUR grade .III in 2.8%. Sensitivity of RBUS for any abnormal findings on VCUG ranged from 5% (specificity: 97%) to 28% (specificity: 77%). Sensitivity for VUR grade .III ranged from 18% (specificity: 97%) to 55% (specificity: 77%). Among the 1203 children aged 2 to 24 months imaged after a first febrile UTI, positive predictive value of RBUS was 37% to 47% for VUR grade .II (13% to 24% for VUR grade .III); negative predictive value was 72% to 74% for VUR grade .II (95% to 96% for VUR grade .III).CONCLUSIONS: RBUS is a poor screening test for genitourinary abnormalities. RBUS and VCUG should be considered complementary as they provide important, but different, information. Dr Nelson conceptualized and refined the study design, performed a substantial portion of data collection and interpretation, and drafted the initial manuscript; Dr Johnson contributed substantially to data collection and interpretation, critically reviewed the manuscript, and incorporated revisions from all the authors; Dr Logvinenko performed data analysis and critically reviewed the manuscript; Dr Chow contributed to conceptualization and refinement of the study design and data interpretation and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. Although the new guidelines do not explicitly frame RBUS as a screening test, the guidelines do suggest that the decision to perform VCUG after a first febrile UTI...

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Section: Discussionmentioning

confidence: 99%

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Nelson¹,

Johnson²,

Logvinenko

et al. 2014

Pediatrics

107

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“…By contrast, other authors claim that US can accurately detect obstructive uropathy, kidney size, renal abscess, and ureterocele in hospitalized children, thereby directly influencing subsequent management based primarily on US examination and suggesting that US should be carried out routinely in children with the first UTI [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 89%

The Role of Renal Ultrasound in Children With Febrile Urinary Tract Infection

Shabbeer

Nizamuddin

2018

Int J Clin Pediatr

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“…18 Evidence to support the use of RUS in VUR is in the setting of initial workup of children with febrile UTI and VUR diagnosis alongside VCUG and DMSA. [7][8][9]19 Additionally, RUS is beneficial as a follow-up imaging modality at discharge and 4 to 6 weeks post-surgical correction of VUR to screen for ureteral obstruction. [7][8][9] The approximate cost of abdominal ultrasound in Alberta is $150 based on a cost to interpret the result by a pediatric radiologist.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9]19 Additionally, RUS is beneficial as a follow-up imaging modality at discharge and 4 to 6 weeks post-surgical correction of VUR to screen for ureteral obstruction. [7][8][9] The approximate cost of abdominal ultrasound in Alberta is $150 based on a cost to interpret the result by a pediatric radiologist. There are additional indirect costs, such as parental time off work, hospital parking and ultrasound technician time, which are more challenging to measure.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The RUS was performed and interpreted at the Hospital for Sick Children in Toronto, Ontario, Canada by a pediatric radiologist. The variables collected included demographic data (age, gender and length of follow-up), VUR history, VUR grade, previous renal scars, number of previous UTIs, and UTIs since last visit, dysfunctional voiding symptoms, and concurrent ultrasound findings (i.e., renal growth, change in the grade of hydronephrosis or presence of new renal scarring).…”

Section: Rudzinski Et Almentioning

confidence: 99%

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Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Rudzinski

Weber

Wildgoose

et al. 2013

CUAJ

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Introduction: Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. Methods: We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. Results: The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. Conclusions: The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

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Febrile Urinary Tract Infections in Infants: Renal Ultrasound Remains Necessary

Abstract: In our population renal ultrasound adds information to the radiographic evaluation of infants after a febrile urinary tract infection. This information alters treatment and parental counseling in a significant number of patients.

Cited by 53 publications

References 12 publications

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

Ultrasound as a Screening Test for Genitourinary Anomalies in Children With UTI

The Role of Renal Ultrasound in Children With Febrile Urinary Tract Infection

Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

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