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Published on: January 10, 2013
Imaging in urinary tract infections: current strategies and new trends
Lorenzo Biassoni1, Samantha Chippington
1Department of Radiology, Great Ormond Street Hospital for Children and Institute of Child Health, University College London, London, United Kingdom. BiassiL@gosh.nhs.uk
Insights
Pediatric urinary tract infection (UTI) imaging is shifting towards risk-based strategies. This approach focuses on identifying children at risk for kidney damage and long-term complications, moving away from universal testing.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urinary Tract Infections
Background:
- Urinary tract infections (UTIs) in children can lead to serious complications like hypertension and chronic renal failure.
- Historically, extensive imaging was recommended for all children under seven with UTIs.
- Evolving evidence suggests a need for more targeted imaging strategies.
Purpose of the Study:
- To review the current landscape of imaging in pediatric urinary tract infections.
- To discuss the evolution of imaging protocols and their impact on managing UTIs.
- To highlight the shift towards risk-stratified imaging approaches.
Main Methods:
- Review of current literature and clinical practice guidelines for pediatric UTI imaging.
- Analysis of the transition from universal cystography to selective imaging.
- Discussion of imaging's role in preventing complications such as renal damage.
Main Results:
- Imaging protocols for pediatric UTIs are transitioning from broad screening to focused investigations.
- There is a discernible move away from routine cystography for all children with UTIs.
- The focus is increasingly on identifying children at high risk for renal sequelae.
Conclusions:
- Current imaging strategies aim to detect abnormalities and prevent complications of UTIs.
- A risk-based approach to imaging in pediatric UTIs is gaining traction.
- Further evaluation is needed for optimal imaging strategies and patient selection.
Abstract:
The aim of imaging in a child with urinary tract infection (UTI) is to detect abnormalities that require appropriate treatment or findings that can be acted on to prevent development of complications (hypertension, chronic renal failure or pregnancy-related complications). Imaging protocols in pediatric urinary tract infections are evolving. From strategies based on extensive investigations in all children younger than 7 years of age, we are slowly moving to imaging strategies focused on children at risk of developing renal damage and possibly long-term complications. The article provides an overview on urinary tract infections, their complications and the use of imaging in their management. The different imaging strategies in children with UTIs (including the recommendation of excluding from imaging certain groups of patients) still needs full evaluation. It is interesting to note, however, a slow move from wide use of cystography in all children with UTI, which has been standard practice for many years but was probably not based on solid scientific evidence, toward a more focused use of cystograms in specific groups of children.
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