Practice guidelines for imaging studies in children after the first urinary tract infection

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Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition
03:19

Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

Published on: June 21, 2024

Mika Venhola1, Niilo-Pekka Huttunen, Marjo Renko

  • 1Departments of Paediatrics, Oulu University Hospital, Oulu and Central Hospital of Central Finland, Jyväskylä, Finland. mika.venhola@ppshp.fi

The Journal of Urology
|May 22, 2010
PubMed

Insights

A clinical decision rule cannot reliably predict grade III-V reflux in children after a urinary tract infection (UTI). This study found the rule impractical for targeting voiding cystourethrograms, impacting current UTI diagnostic guidelines in pediatrics.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Diagnostic Accuracy

Background:

  • Urinary tract infections (UTIs) are common in children and can indicate underlying urinary tract pathology.
  • Vesicoureteral reflux (VUR) is often investigated after a child's first UTI, but occurs in less than 25% of cases.
  • Voiding cystourethrogram (VCUG) carries risks and efficient targeting is crucial.

Purpose of the Study:

  • To validate a pre-established clinical decision rule for predicting VUR in children post-UTI.
  • To assess the rule's efficiency in targeting VCUG investigations.
  • To determine if the rule can refine current diagnostic guidelines for pediatric UTIs.

Main Methods:

  • A clinical decision rule was tested in 406 children under 5 years with acute UTIs.
  • Data collected included UTI symptoms, signs, and imaging findings.
  • The rule's sensitivity for predicting grade III-V VUR was analyzed.

Main Results:

  • Vesicoureteral reflux was identified in 35% of children; grade III-V VUR in 20%.
  • Abnormal ultrasound findings (18%) did not correlate with VUR.
  • The clinical decision rule demonstrated poor sensitivity (24%) for detecting grade III-V VUR.

Conclusions:

  • The clinical decision rule is not a reliable method for predicting grade III-V VUR in children with UTIs.
  • The current guidelines recommending VUR investigation after pediatric UTIs cannot be revised using this specific decision rule.
  • Predicting VUR in children with UTIs using this rule was found to be impractical.
Abstract

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