Value of Ultrasound in Evaluation of Infants With First Urinary Tract Infection

Preda, Iulian; Jodal, Ulf; Sixt, Rune; Stokland, Eira; Hansson, Sverker

doi:10.1016/j.juro.2010.01.032

Cited by 58 publications

(46 citation statements)

References 18 publications

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“…The present study reveals that US has modest sensitivity (68.4%) and NPV (87.6%) for disclosing grades III-V VUR. This is consistent with previously reported values for detecting high grade VUR [18,28,29].…”

Section: Discussionsupporting

confidence: 93%

“…Published studies report that the ability of US to detect grades I-V VUR is poor and varies among studies, with a sensitivity of 16-40% and NPV of 25-86% [10,12,14,15]. However, improved detection rates have been reported in children with grades III-V VUR, with a sensitivity of 63-86% and NPV of 70-94% [18,28,29]. The present study reveals that US has modest sensitivity (68.4%) and NPV (87.6%) for disclosing grades III-V VUR.…”

Section: Discussionmentioning

confidence: 99%

“…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: 98%

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

Shabbeer

Nizamuddin

2018

Int J Clin Pediatr

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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

Shabbeer

Nizamuddin

2018

Int J Clin Pediatr

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“…10 Some authors found important indications of doing USG in evaluation of UTI. 26,27 But others showed that it is not sensitive nor specific for detection of VUR in children with first UTI. 28,29 Even though it is done routinely in some centers for evaluation of lower urinary tract in children with first UTI to exclude congenital anomalies particularly when the prenatal USG evaluation was absent.…”

Section: Discussionmentioning

confidence: 99%

Association of Vesicoureteric Reflux (VUR) in Children with Symptomatic Urinary Tract Infection (UTI) - in a Tertiary Care Hospital, Dhaka, Bangladesh

Begum

Rahman

Hossain

et al. 2013

Bangladesh J Child Health

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“…The majority will have a normal scan and among these few will present a recurrence. The strength of this study is to have linked abnormal DSMA with risk of recurrent UTI as most previous studies have focused on the relationship between results of various diagnostic tests and the presence or absence of VUR or probability of resolution of VUR [6][7][8][9][10][11][12][13][14][15][16].…”

mentioning

confidence: 99%

Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections

et al. 2018

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The ideal management of a child presenting a first episode of febrile urinary tract infection is still under debate. In the recent guidelines for the diagnosis and management of urinary tract infections (UTI) in children, the American Association of Pediatrics recommend performing a post-UTI sonography, and if there are abnormal findings, a voiding cystourethrogram [1]. This change derives from the understanding that we should be avoiding renal damage rather more than diagnosing reflux, since both surgery and antibiotic prophylaxis are progressively being abandoned for most cases of vesicoureteral reflux (VUR) [2,3]. The most significant event which will bring a child to active management is recurrence of UTI [4,5]. It seems therefore more clinically relevant to differentiate between children who will suffer recurrent episodes of UTI and those who will not, rather than to simply identify which children have VUR. We therefore aimed to evaluate if DMSA nuclear scan could reliably identify which children were at risk of presenting a second febrile UTI.We retrospectively analyzed all children aged between 2 and 24 months, without prenatally diagnosed uropathy, who were admitted to our institution for a first febrile UTI between 2009 and 2013, had a post-urinary tract infection sonography and DMSA nuclear scan, and were followed for at least 24 months. We excluded patients with missing or incomplete data, or lost to follow-up. Febrile UTI was defined as fever > 38 °C associated with positive urinalysis and urine culture (> 10 5 CFU/mL urine) collected through catheterization in girls, and clean-catch in boys. We noted patient's characteristics, and the results of the DMSA scan performed within 1 month of the acute episode. DMSA scans were categorized as normal, i.e., no scarring or dysplasia, or abnormal, any degree of scarring or dysplasia, functional impairment or atrophy.After the first febrile UTI, parents were systematically counseled about early diagnosis and having a urinalysis done if their child presented unexplained fever. None were given antibiotic prophylaxis but they were given advice about local hygiene and measures to avoid constipation in their child. All children were followed at least once every 6 months for a minimum of 24 months. The main outcome was recurrence of a second febrile UTI within the first 24 months of follow-up. In case of recurrence, a cystogram was performed, and children were further managed accordingly.On hundred and seven children were included in our study. There were 49 boys and 58 girls (45.8/54.2%). None were lost to follow-up, and all relevant data were available for all included patients. Children included did not differ from those who were excluded from the study. The mean age at first febrile UTI was 6.8 ± 5.4 months. Twenty-four (22.4%) children presented abnormal DMSA findings. Six presented asymmetric function without signs of dysplasia or scarring, two had a solitary kidney, and 16 had signs of dysplasia or scarring, of which 6 had asymmetric function. Sixteen (14.9%)...

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Value of Ultrasound in Evaluation of Infants With First Urinary Tract Infection

Cited by 58 publications

References 18 publications

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

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

Association of Vesicoureteric Reflux (VUR) in Children with Symptomatic Urinary Tract Infection (UTI) - in a Tertiary Care Hospital, Dhaka, Bangladesh

Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections

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