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A protocol for the investigation of infants and children with urinary tract infection
K M Whyte1, G D Abbott, J C Kennedy
1Department of Radiology, Christchurch Hospital, New Zealand.
Insights
This study details a protocol for diagnosing reflux nephropathy in children, minimizing invasive tests. The policy is effective, recommending voiding cysto-urethrography for persistent infections.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
Background:
- Reflux nephropathy is a significant cause of kidney scarring in children.
- Early detection and management are crucial to prevent long-term renal damage.
Purpose of the Study:
- To describe and evaluate a minimally invasive investigation protocol for reflux nephropathy in pediatric patients.
- To assess the appropriateness of the protocol after a 5-year review.
Main Methods:
- The protocol differentiates investigation based on patient age (<2 years vs. >2 years) and urinary tract infection (UTI) status.
- Intravenous urography (IVU) and voiding cysto-urethrography (VCUG) are used for younger children with UTI.
- Children over 2 years with UTI receive IVU, with VCUG reserved for abnormal findings.
Main Results:
- The 5-year review indicated the protocol's appropriateness in reducing invasive procedures.
- The protocol effectively identifies reflux nephropathy while minimizing patient discomfort and radiation exposure.
- Continued infections in children over 2 necessitate further evaluation, including VCUG.
Conclusions:
- The described investigation protocol is a safe and effective approach for diagnosing reflux nephropathy in infants and children.
- The protocol balances diagnostic accuracy with the need to minimize invasive procedures.
- Ongoing evaluation, particularly VCUG for recurrent UTIs, ensures comprehensive care.
Abstract:
An investigation protocol, designed to reduce invasive procedures to a minimum, is described for the detection of reflux nephropathy in infants and children. Intravenous urography and voiding cysto-urethrography is necessary in patients up to the age of 2 years presenting with urinary tract infection, but in children over 2 years of age the protocol limits the investigation to an intravenous urogram unless this is abnormal. A review of this policy after 5 years has indicated that it is appropriate provided that children who continue to have infections have further evaluation including a voiding cysto-urethrogram.