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Imaging strategy for infants with urinary tract infection: a new algorithm.

Iulian Preda¹, Ulf Jodal, Rune Sixt

¹Department of Pediatrics, Queen Silvia Children's Hospital, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. iulian.preda@vgregion.se

The Journal of Urology

|January 21, 2011

Summary

Elevated C-reactive protein and specific ultrasound measurements can predict permanent kidney damage in infants after a first urinary tract infection, aiding in diagnostic imaging decisions.

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Area of Science:

Pediatric Nephrology
Diagnostic Imaging
Infectious Diseases

Background:

Urinary tract infections (UTIs) are common in infants and can lead to permanent renal damage.
Accurate prediction of renal damage is crucial for appropriate management and follow-up.
Current diagnostic protocols may involve extensive imaging, necessitating more targeted approaches.

Purpose of the Study:

To identify clinical and laboratory predictors of permanent renal damage in infants with a first-time UTI.
To evaluate the utility of C-reactive protein (CRP) and ultrasound measurements in predicting renal damage.
To develop a basis for an optimized imaging algorithm for infants with UTIs.

Main Methods:

A prospective, population-based study of 290 infants with a first UTI.
Acute investigations included ultrasonography, dimercaptosuccinic acid (DMSA) scintigraphy, and voiding cystourethrography.
Late DMSA scintigraphy at 1 year assessed for renal damage, with clinical data analyzed for predictive factors.

Main Results:

Of 270 patients with follow-up data, 70 exhibited renal damage.
Independent predictors of permanent renal damage included CRP, serum creatinine, leukocyturia, anteroposterior diameter on ultrasound, and non-Escherichia coli bacterial infections.
A combination of CRP ≥70 mg/l and anteroposterior diameter ≥10 mm showed 87% sensitivity and 59% specificity for renal damage.

Conclusions:

C-reactive protein levels, along with anteroposterior renal diameter, are significant predictors of permanent renal damage in infants with UTIs.
These findings support the development of a refined imaging algorithm to guide the diagnostic workup.
Optimizing imaging strategies can reduce unnecessary procedures while identifying at-risk infants.