Related Experiment Videos
Radiographic evaluation of children with urinary tract infections
1University of Utah School of Medicine, Salt Lake City.
Insights
Pediatric urinary tract infections require prompt radiologic work-up to assess renal damage risk. Imaging choices like VCUG, ultrasonography, and radionuclide scans guide management based on infection response and findings.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Nephrology
Background:
- Urinary tract infections (UTIs) are common in children and can lead to significant renal damage.
- Radiologic imaging is crucial for diagnosing complications and guiding treatment strategies.
- Timely and appropriate imaging is essential for preventing long-term renal sequelae.
Purpose of the Study:
- To outline a systematic approach to radiologic work-up for pediatric UTIs.
- To delineate the roles of various imaging modalities in evaluating renal damage and complications.
- To guide clinicians in selecting appropriate imaging based on clinical presentation and initial findings.
Main Methods:
- Review of current guidelines and literature on pediatric UTI imaging.
- Discussion of indications for Voiding Cystourethrography (VCUG), ultrasonography, CT scans, and radionuclide scans.
- Emphasis on sequential imaging strategies based on infection response and initial results.
Main Results:
- VCUG (fluoroscopic or isotopic) is the initial recommended study for all children with UTI.
- Ultrasonography is indicated if the infection responds and VCUG is normal.
- Radionuclide scans or excretory urography are used when VCUG shows reflux to assess parenchymal damage.
- Ultrasonography or CT scan is crucial for suspected abscesses in non-responding infections.
- Specific protocols exist for infants with UTI and sepsis, and for complex cases.
Conclusions:
- A tailored radiologic approach is vital for managing pediatric UTIs and preventing renal damage.
- The choice of imaging modality depends on clinical factors, including infection response and presence of reflux.
- Judicious use of imaging modalities ensures accurate diagnosis, effective management, and monitoring of complications.
Abstract:
Any child with urinary tract infection needs a radiologic work-up to determine his or her potential risk for sustaining renal damage. VCUG, either fluoroscopic or isotopic, should always be performed. If the infection responds to treatment and the VCUG is normal, ultrasonography should be performed. However, when the VCUG demonstrates reflux, radionuclide scan or, less preferably, excretory urography is indicated to assess renal parenchymal damage and function. When a urinary tract infection does not respond to treatment, ultrasonography or CT scan should be obtained to check for renal or perirenal abscess. If the findings are normal, medical treatment to control the infection is indicated. Further evaluation of the urinary tract may be temporarily delayed. In an infant with urinary tract infection and sepsis, renal ultrasonography is indicated. If the sonogram is normal, VCUG can be delayed until the infant responds to medical treatment. If ultrasonography is abnormal, VCUG and radionuclide scan such as 99mtechnetium DTPA with furosemide to evaluate gross morphology and function should be obtained. Complicated medical problems, such as urinary tract infection in combination with a history of intravenous drug abuse or with findings of fever and a mass, deserve immediate evaluation with ultrasonography or CT scan. A patient with fever of unknown origin and normal urine culture should have a radionuclide scan using gallium67 citrate or indium111-tagged leukocytes, both of which can demonstrate an extrarenal or unsuspected intrarenal site of infection. A variety of imaging modalities are available today for investigating urinary tract infections in the pediatric patient. Used intelligently, singly or in combination, these examinations provide information for the clinical evaluation as well as short-and long-term management of infections, their causes and complication, and their effect on renal function.