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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Evaluating the requirement of ultrasonography for children with their first urinary tract infection
Orkun Aydin1, Selmin Karademir2, Mehmet Bülbül3
1Department of Pediatrics, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
Insights
Selective renal and bladder ultrasonography (RBUS) for children with atypical urinary tract infections (UTIs) or recurrent UTIs can reduce imaging rates without missing significant kidney anomalies. This approach optimizes diagnosis for pediatric UTIs.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging in Urology
- Infectious Diseases in Children
Background:
- Urinary tract infections (UTIs) in children are critical for identifying congenital abnormalities of the kidney and urinary tract (CAKUT).
- Current diagnostic protocols often involve extensive imaging, raising questions about efficiency and necessity.
Purpose of the Study:
- To evaluate a selective diagnostic approach for pediatric UTIs using renal and bladder ultrasonography (RBUS).
- To determine if performing RBUS only for atypical first UTIs or recurrent UTIs misses significant kidney anomalies.
Main Methods:
- Retrospective analysis of 178 pediatric patients (2 months-2 years) diagnosed with UTI.
- Evaluation of RBUS and voiding cystourethrography (VCUG) findings based on pathogen type and UTI recurrence.
- Simulated application of a selective RBUS protocol.
Main Results:
- E. coli was the pathogen in 58.4% of cases; atypical pathogens in 41.6%.
- VCUG identified vesicoureteral reflux (VUR) in 16 patients and ureteropelvic junction obstruction (UPJO) in 1.
- A selective RBUS strategy would have missed only two severe kidney anomalies, potentially reducing RBUS by 40.4% and VCUG by 20%.
Conclusions:
- A selective diagnostic strategy for pediatric UTIs, targeting atypical pathogens or recurrent infections for RBUS, minimizes unnecessary imaging.
- This approach offers a significant reduction in imaging procedures with minimal risk of overlooking critical CAKUT.
Background:
Management of urinary tract infection (UTI) in children remains important. It may be the first sign for a possible underlying congenital abnormalities for the kidney and urinary tract (CAKUT). This study examined whether performing renal and bladder ultrasonography (RBUS) only for children who have a pathogen other than E. coli during their first urinary tract infection (UTI), or who experience UTI recurrence, would result in more missed diagnoses of kidney anomalies.
Methods:
Patients aged between 2 months and 2 years who were seen in a tertiary pediatric hospital during a 2-year period and diagnosed with UTI were included. RBUS and voiding cystourethrography (VCUG) were performed according to American Academy of Pediatrics (AAP) guidelines. Afterwards, we looked back and evaluated how often we found kidney problems when we only did a RBUS on patients who had an atypical cause of their first UTI or who had multiple UTIs.
Results:
One hundred and seventy-eight patients who were followed up with UTI were included in this study. The isolated pathogen was E. coli in 104 cases (58.4 %) and atypical in 74 cases (41.6 %). VCUG was conducted on 40 patients, and vesicoureteral reflux (VUR) was discovered in 16 cases and ureteropelvic junction obstruction (UPJO) was discovered in 1 case. A different diagnostic approach that required the presence of an atypical pathogen at the first UTI or a fUTI recurrence to perform the RBUS would have missed just two severe kidney anomalies. It was observed that there could be a decrease of 40.4 % in RBUS and at least 20 % in VCUG.
Conclusions:
A diagnostic approach that necessitates the presence of an abnormal pathogen during the initial UTI or a second UTI episode for the RBUS to be carried out would lead to fewer negative ultrasounds with minimal risk of overlooking kidney anomalies.
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