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Intravenous pyelography in children with urinary tract infection and vesicoureteral reflux
1Section of Pediatric Nephrology, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Intravenous pyelography (IVP) may not be necessary for children with normal ultrasounds and low-grade vesicoureteral reflux (VUR). Further evaluation is only needed if ultrasounds show abnormalities, even with low-grade VUR.
Area of Science:
- Pediatric Radiology
- Urology
Background:
- Intravenous pyelography (IVP) is often recommended for children with urinary tract infections (UTIs) and abnormal imaging.
- Its benefit is questionable in cases of normal ultrasonography (US) and low-grade vesicoureteral reflux (VUR).
Purpose of the Study:
- To evaluate the necessity of IVP in children with UTIs, normal US, and low-grade VUR.
- To determine if IVP provides additional diagnostic value in these specific cases.
Main Methods:
- Retrospective analysis of 52 children with UTIs and VUR over 3 years.
- Comparison of findings from renal ultrasonography and IVP.
- Correlation of imaging results with the grade of VUR and need for surgical intervention.
Main Results:
- Of 44 low-grade VUR cases, 38 had normal US and normal/minor IVP findings, with no surgery needed.
- Six low-grade VUR cases with abnormal US showed abnormal IVP, requiring surgery in two.
- Ten of 14 medium-grade VUR cases had normal US, but six showed abnormal IVP findings.
Conclusions:
- IVP may be unnecessary for children with normal US and low-grade VUR.
- Abnormal US findings in the presence of low-grade VUR warrant further IVP investigation.
- IVP remains valuable for medium-grade VUR, even with initially normal US.
Abstract:
In a previous study of the radiologic evaluation of children with urinary tract infection it was recommended that IVP be performed in all patients with either abnormal ultrasonographic or voiding cystourethrographic findings. However, the benefit from IVP was believed to be questionable in children with normal ultrasonography findings and vesicoureteral reflux of only a low grade (I or II of V). To gain a better understanding of the need for IVP in the radiologic evaluation of such children, the database was expanded and the findings concerning ultrasonography and IVP were analyzed in 52 children with urinary tract infection and vesicoureteral reflux seen during the last 3 years. Of a total of 72 instances of reflux, 44 (61.1%) were of low grade (I or II), 14 of medium grade (III), and 14 of high grade (IV or V). Of the 44 urinary systems with low-grade reflux, results were as follows: renal ultrasonography appeared normal in 38 and in 34 of these, the IVP also appeared normal; in the other four, only minor and negligible changes were seen with IVP. Surgical intervention was not necessary in any of these 38 urinary systems. In six systems with low-grade vesicoureteral reflux but with abnormal ultrasonography findings, IVP results were also abnormal, and surgery was necessary in two instances. Of the 14 urinary systems with medium-grade reflux, ultrasonography appeared normal in ten but in six of these the IVP appeared abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)