The value of renal ultrasound in children with a first episode of urinary tract infection

Abstract

BACKGROUND:Urinary tract infection (UTI) is a common pediatric problem. Guidelines recommend obtaining a renal ultrasonogram (RUS) for young children after a first UTI. Our aim was to assess the value of routine RUS in the management of children hospitalized with a first episode of UTI.METHODS:We conducted a retrospective review of the medical records of 130 children 12 years of age or younger admitted with a first UTI. Children were excluded if they had a urinary tract abnormality before admission and/or had been treated with an antibacterial agent within 7 days before admission. The yield of RUS was measured by ability to detect renal abnormalities, by the sensitivity and specificity for detecting vesicoureteral reflux (VUR) using voiding cystourethrogram (VCUG) as a gold standard, and by its influence on UTI management.RESULTS:RUS was conducted in 130 children, but only 118 returned for a VCUG and were included in the study. The findings were positive for VUR in 20 of 40 patients (50%) with a confirmed VUR on VCUG and positive in 18 of 78 patients (23.1%) without VUR on VCUG. Of the 20 patients with a normal RUS who showed VUR, 2 had grade I reflux, 8 had grade II reflux, 7 had grade III reflux and 3 had grade IV reflux. The sensitivity, specificity, positive and negative predictive value of ultrasound in suggesting VUR was 50% and 76.9%, 52.6% and 75%, respectively. Except for one, the result of an abnormal RUS did not alter the management of our patients.CONCLUSION:The results of our study show that the RUS has a little value in the management of children with a first UTI.

Significance of Sonographically Demonstrated Ureteral Dilatation in Evaluation of Vesicoureteral Reflux Verified with Voiding Urosonography in Children with Urinary Tract Infection

“…In our study, prevalence of VUR in children with a history of urinary tract infections was 50.8%, which is considerable compared to the similar studies ( 4 , 5 , 17 , 18 , 19 , 20 ); this confirmed the fact that of those children routinely presenting for investigation of reflux about half do not have reflux ( 10 ). Our finding demonstrates the importance of selection of patients that would very likely not have reflux on VCUG or RNC, thus eliminating unnecessary X-ray exposure.…”

Contrast‑enhanced voiding urosonography with intravesical administration of ultrasound contrast agent for the diagnosis of pediatric vesicoureteral reflux

“…The application of harmonic ultrasound further enhanced the specificity of CeVUS in the diagnosis of VUR ( 11 ), making it a reliable diagnostic method in Europe ( 17 ). In the present study, 44/90 children (48.79%) and 65/178 PUUs (36.52%) were diagnosed as VUR positive using CeVUS, which is consistent with a previous study ( 18 ) and suggests that >50% of high-risk children were VUR negative. VCUG results for 2 children indicated that they were VUR negative, whereas CeVUS later revealed that they were positive for VUR.…”

Renal ultrasound and voiding cystourethrogram in children with recurrent urinary tract infection

“…3 Layla et al reports 50% sensitivity and 76.9% specificity. 5 In our study VUR was identified in 24.5% whereas in a larger series 3 VUR was identified in 41.7%. Other study reports 22% prevalence, 40% sensitivity, 76% specificity, 32% positive and 82% negative predictive value.…”