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Renal ultrasound evaluation of urinary tract infections in children
Insights
Renal ultrasound is a safe and accurate alternative to intravenous pyelogram for diagnosing urinary tract infections in children. Ultrasound also helps identify infection site by measuring kidney volume changes.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Intravenous pyelogram (IVP) has been the standard for diagnosing UTIs.
- Concerns exist regarding radiation exposure and patient discomfort with IVP.
Purpose of the Study:
- To evaluate the efficacy of renal ultrasonography compared to IVP in identifying treatable abnormalities in children with UTIs.
- To assess the utility of ultrasound in determining the probable site of UTI based on kidney volume changes.
Main Methods:
- Retrospective analysis of 64 children with UTIs who underwent IVP, renal ultrasound, and voiding cystogram.
- Prospective evaluation of 43 children where IVP was performed only if ultrasound or cystogram were abnormal.
- Measurement of kidney volume changes in relation to UTI site.
Main Results:
- Renal ultrasound identified four treatable abnormalities, all confirmed by IVP.
- IVP identified only one treatable abnormality (calyceal dilation), missed by ultrasound.
- Significant kidney volume increase (>30%) was observed in 15/18 children with upper UTIs versus 4/21 with lower UTIs (P < .005).
Conclusions:
- Renal ultrasound is accurate, safe, and well-accepted, making it a suitable replacement for IVP in children with normal cystograms.
- Ultrasound-based kidney volume measurement offers a novel, noninvasive method to localize the probable site of UTI.
Abstract:
Ultrasonography of the kidney may replace the intravenous pyelogram as the study of choice in identifying treatable abnormalities in children with urinary tract infection. In a series of 64 consecutive children with urinary tract infection in whom an intravenous pyelogram, renal ultrasound, and voiding cystogram were performed, only one treatable abnormality (calyceal dilation) was identified by intravenous pyelogram, and it was not detected by ultrasound. Eleven children showed vesicoureteral reflux on the cystogram. In an additional 43 children in whom intravenous pyelogram was done only if the ultrasound or cystogram were abnormal, there were five abnormal cystograms. Four treatable abnormalities were identified by ultrasound, and there were confirmed by the intravenous pyelogram. Ultrasound should replace the intravenous pyelogram in children with a normal cystogram because of its accuracy, safety, and high patient acceptance. We have also documented a significant volume increase with acute infection in one or both kidney(s) of those children having upper urinary tract infection. Fifteen of 18 children with upper urinary tract infection had volume increases of 30% or more in at least one kidney; whereas only four of 21 children with lower urinary tract infection had increases of greater than 30% (P less than .005). Ultrasound volume measurements provide a new, noninvasive method for identifying the probable site of urinary tract infection.