What Did We Find From Imaging Studies in Childhood Urinary Tract Infection and Which Studies Are Mandatory?

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Urology

Background:

• Childhood urinary tract infections (UTIs) can lead to significant renal complications.
• Recent international guidelines suggest selective imaging for UTIs, but their applicability in diverse settings requires evaluation.
• Congenital anomalies of the kidney and urinary tract (CAKUT) are a common concern in pediatric UTIs.

Purpose of the Study:

• To assess the diagnostic yield of imaging studies for childhood UTIs in Thailand.
• To determine the prevalence of CAKUT and renal damage following UTI in Thai children.
• To evaluate the appropriateness of current international guidelines for imaging practices in Thailand.

Main Methods:

• Retrospective review of medical records for children aged 0-15 years with UTI.
• Analysis of imaging results including renal ultrasound (RUS), cystogram, and 99mTc dimercaptosuccinic acid (DMSA) renal scan.
• Classification of CAKUT as mild (grades I-III VUR or isolated hydronephrosis) or severe.

Main Results:

• CAKUT was detected in 54.6% of children, with 43 cases classified as severe.
• Renal ultrasound (RUS) abnormalities were found in 37.8% of cases.
• Combined RUS and cystogram demonstrated higher sensitivity (100%) and specificity (53.8%) for severe CAKUT compared to RUS with DMSA.

Conclusions:

• More than half of children with a first UTI present with CAKUT, a significant proportion being severe.
• The combination of RUS and cystogram remains the most reliable method for identifying post-UTI complications in this setting.
• Current Western guidelines for imaging after childhood UTI are not suitable for routine practice in Thailand.