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Imaging in urinary tract infection
1Imaging Department, Hospital for Sick Children, London.
Insights
Vesicoureteric reflux (VUR) and renal scarring in children with urinary tract infections show a strong link. However, VUR detection poorly correlates with scarring in children over one year old, suggesting kidney imaging first.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteric reflux (VUR) and renal scarring are significant concerns following UTIs.
- The diagnostic approach to identify these conditions is crucial for preventing long-term kidney damage.
Purpose of the Study:
- To investigate the relationship between VUR and renal scarring in children with UTIs.
- To evaluate the diagnostic utility of DMSA scans and cystograms in different age groups.
- To determine the optimal imaging strategy for children presenting with UTIs.
Main Methods:
- A cohort of 94 children (188 kidneys) with confirmed UTIs were studied.
- All participants underwent a micturating cystourethrogram (MCU) and a 99mTc DMSA scan.
- Data on VUR, renal scarring, and patient age were collected and analyzed.
Main Results:
- Of 188 kidneys, 42 showed scarring and 70 had VUR.
- Scarring was present in 37.1% of kidneys with VUR, while 61.9% of scarred kidneys had VUR.
- In children over 1 year, VUR detection showed a poor correlation with renal scarring.
Conclusions:
- A strong correlation exists between DMSA-detected renal scarring and the presence of VUR.
- In children over one year old with UTIs, DMSA scans should be the primary imaging modality.
- Cystograms should be reserved for cases where the DMSA scan reveals abnormalities, optimizing diagnostic pathways.
Abstract:
The relationship of vesicoureteric reflex (VUR) and renal scarring was studied in 94 children (188 kidneys) with proved urinary tract infection in a district general hospital. There were 61 girls and 33 boys, with nine girls and 17 boys aged less than 1 year, 31 girls and nine boys aged between 1 and 5 years, the remaining 28 children were over 5 years of age. All children had a micturating cystourethrogram and a 99mTc (technetium) dimercaptosuccinic acid (DMSA) scan. Forty two of the 188 kidneys were scarred and 70 of the kidneys had VUR. Only 37.1% of the kidneys with reflux were scarred but 61.9% of the scarred kidneys had VUR. In children of less than 1 year, 48% of kidneys with VUR were scarred whereas 70.6% of scarred kidneys had reflux. In children between 1 and 5 years of age only 36.4% of kidneys with VUR were scarred but 63.2% of scarred kidneys had VUR. There is good correlation between the detection of a scarred kidney on DMSA and the presence of vesicoureteric reflux. However the detection of reflux particularly in children over 1 year of age shows poor correlation with renal scarring. This suggests that the primary imaging in children over 1 year of age presenting with a urinary tract infection should be of the kidney: a cystogram should be performed only if the DMSA scan is abnormal.