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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Radiologic and clinical evaluation of children with first febrile urinary tract infection
A Nickavar1, B Safaeian2, M Biglari Abhari3
1Department of Pediatric Nephrology, Iran University of Medical Sciences, Tehran, Iran.
Insights
Accurate diagnosis of acute pyelonephritis (APN) in children is challenging. Ultrasound is valuable for excluding high-grade vesicoureteral reflux (VUR), while inflammatory markers aid APN evaluation.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Accurate diagnosis of acute pyelonephritis (APN) in young children remains a clinical challenge.
- Recent revisions in evaluation methods for APN and vesicoureteral reflux (VUR) necessitate updated diagnostic strategies.
- Understanding the utility of various radiologic investigations is crucial for effective management.
Purpose of the Study:
- To evaluate the diagnostic value of different radiologic investigations for children experiencing their first episode of APN.
- To assess the effectiveness of imaging modalities in identifying APN and its associated risk factor, VUR.
- To determine the correlation between imaging findings and clinical/laboratory markers of infection.
Main Methods:
- Study included 425 children aged 2-12 months with confirmed APN.
- APN definition: positive urine culture with DMSA scan findings of decreased cortical uptake.
- Radiologic investigations included renal ultrasonography and DMSA scans; VUR diagnosis was confirmed by standard methods.
Main Results:
- Fever (≥38.5°C), elevated CRP, ESR, and leukocytosis were common in APN patients.
- Renal ultrasonography showed limited sensitivity (34%) and specificity (53%) for APN findings.
- Ultrasound demonstrated moderate sensitivity (42.7%) but low specificity (27%) for VUR diagnosis, though diagnostic rates correlated with VUR severity. DMSA scan was unreliable for VUR diagnosis.
Conclusions:
- Determination of inflammatory markers is recommended for evaluating children with APN.
- A normal renal ultrasound is a valuable tool for excluding high-grade VUR in pediatric patients.
- Further research may refine imaging protocols for APN and VUR diagnosis in children.
Background And Objectives:
Accurate diagnosis of acute pyelonephritis (APN) is clinically challenging in young children. The evaluation methods for APN and its major risk factor, vesicoureteral reflux (VUR), have been revised in recent years. The aim of this study was to evaluate the value of different radiologic investigations in children experiencing the first episode of APN.
Materials And Methods:
This study included 425 children of 2-12 months of age (17.5% male, 82.5% female) with APN. APN was defined as a positive urine culture associated with focal or diffuse decreased cortical uptake and preservation of renal contour indicated by DMSA renal scan.
Results:
The mean age at diagnosis was 39.2 ± 1.56 months. The following signs were observed in the patients: fever ≥ 38.5 °C, 66.8%; positive CRP, 85.4%; ESR > 25, 78.6%; and leukocytosis > 13,000/mm3, 53.4%.Pyelocalyceal fullness and increased parenchymal echogenicity were the most common renal ultrasonography findings, and ultrasonography had 34% sensitivity and 53% specificity for these two findings. DMSA scan and ultrasound findings of APN were not significantly correlated (P = .112).VUR was found in 42.2% of patients. DMSA scanning was not reliable for the diagnosis of VUR (P = .956), with 42% sensitivity and specificity.VUR was identified in 42.7% of patients by ultrasound (P = .001), and the diagnostic rate was related to the VUR severity. Ultrasound had 42.7% sensitivity and 27% specificity for the diagnosis of VUR.
Conclusion:
Determination of inflammatory markers is recommenced for the evaluation of children with APN. In addition, normal ultrasound is a valuable imaging tool for excluding high grade VUR.
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