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Published on: August 14, 2019
Ultrasound as a screening test for genitourinary anomalies in children with UTI
Caleb P Nelson1, Emilie K Johnson, Tanya Logvinenko
1Department of Urology;
Insights
Renal and bladder ultrasound (RBUS) has low sensitivity for detecting genitourinary abnormalities in children with urinary tract infections (UTIs). Voiding cystourethrogram (VCUG) remains crucial for diagnosing conditions like vesicoureteral reflux (VUR).
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Current guidelines recommend renal and bladder ultrasound (RBUS) after a febrile urinary tract infection (UTI) in young children.
- Voiding cystourethrogram (VCUG) is typically reserved for cases with abnormal RBUS findings.
Purpose of the Study:
- To evaluate the diagnostic accuracy and predictive values of RBUS for detecting genitourinary abnormalities on VCUG in children with UTI.
- To assess the utility of RBUS as a screening tool in this population.
Main Methods:
- Retrospective analysis of 3995 clinical encounters involving both RBUS and VCUG for UTI history.
- Exclusion of patients with prior genitourinary imaging or prenatal hydronephrosis.
- Calculation of sensitivity, specificity, and predictive values of RBUS for VCUG findings.
Main Results:
- RBUS was normal in 75% of cases. Any vesicoureteral reflux (VUR) was found in 41.7% on VCUG.
- RBUS demonstrated low sensitivity (5%-28%) for detecting any VCUG abnormality and VUR grade >III (18%-55%).
- Positive predictive value of RBUS for VUR grade >II was 37%-47%, while negative predictive value was 72%-74%.
Conclusions:
- RBUS is an inadequate screening test for genitourinary abnormalities in children with UTI.
- RBUS and VCUG provide complementary information and should be used together for comprehensive diagnosis.
Background:
The 2011 American Academy of Pediatrics guidelines state that renal and bladder ultrasound (RBUS) should be performed after initial febrile urinary tract infection (UTI) in a young child, with voiding cystourethrogram (VCUG) performed only if RBUS shows abnormalities. We sought to determine test characteristics and predictive values of RBUS for VCUG findings in this setting.
Methods:
We analyzed 3995 clinical encounters from January 1, 2006 to December 31, 2010 during which VCUG and RBUS were performed for history of UTI. Patients who had previous postnatal genitourinary imaging or history of prenatal hydronephrosis were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined.
Results:
We identified 2259 patients age <60 months who had UTI as the indication for imaging. RBUS was reported as "normal" in 75%. On VCUG, any vesicoureteral reflux (VUR) was identified in 41.7%, VUR grade >II in 20.9%, and VUR grade >III in 2.8%. Sensitivity of RBUS for any abnormal findings on VCUG ranged from 5% (specificity: 97%) to 28% (specificity: 77%). Sensitivity for VUR grade >III ranged from 18% (specificity: 97%) to 55% (specificity: 77%). Among the 1203 children aged 2 to 24 months imaged after a first febrile UTI, positive predictive value of RBUS was 37% to 47% for VUR grade >II (13% to 24% for VUR grade >III); negative predictive value was 72% to 74% for VUR grade >II (95% to 96% for VUR grade >III).
Conclusions:
RBUS is a poor screening test for genitourinary abnormalities. RBUS and VCUG should be considered complementary as they provide important, but different, information.
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