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[Imaging methods in the study of urinary tract infections in children]
H N Almeida1, M Ribeiro, J Colarinha
1Unidade de Nefrologia Pediátrica, HSM-Universidade de Lisboa.
Insights
Detecting renal scars and urinary tract anomalies in children with recurrent urinary tract infections (UTIs) is crucial. Renal ultrasound, DMSA scans, and cystograms effectively guide diagnosis, with DMSA scans vital for identifying unsuspected renal scarring.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Context:
- Recurrent urinary tract infections (UTIs) in children necessitate thorough investigation for renal and urologic anomalies.
- Early detection of renal scarring and anomalies is critical for appropriate management and preventing long-term complications.
Purpose:
- To evaluate the diagnostic utility of renal and vesical ultrasound (US), DMSA scan, and cystogram in children with a history of UTIs.
- To determine the effectiveness of these imaging modalities in detecting renal scars and urologic anomalies.
Summary:
- A study of 148 children with recurrent UTIs assessed diagnostic information from US, DMSA scans, and cystograms.
- Results indicated that DMSA scans are particularly important for identifying renal scars, even when other tests are normal.
- Vesicoureteral reflux (VUR) and vesical dysfunction were identified in a significant proportion of children, often correlating with imaging findings.
Impact:
- The combined use of US, DMSA scans, and cystograms effectively directs the diagnostic approach for pediatric UTIs.
- The DMSA scan plays a key role in diagnosing unsuspected renal scars, contributing to better patient outcomes.
- Findings highlight the importance of comprehensive imaging in managing children with complex UTI presentations.
Unlabelled:
When studying a child with urinary tract infection it is important to detect and localize any renal (scar) or urologic anomaly. Here we study the information obtained using: renal and vesical ultrasound (US), DMSA scan and radiologic or isotopic cystogram.
Methods:
We studied 148 children with more than one urinary tract infection and/or pyelonephritis; their mean age was 35.9 months (1-148 months); 55% were girls. The three diagnostic examinations--US, DMSA scan and cystogram were made in the order; the DMSA scan or cystogram was never made sooner than one month after the UTI.
Results:
In 42% of the children the three exams were normal; 4 of these children had another UTI and the urodynamic study revealed vesical disfunction. 11% had renal scars (DMSA scan) with normal US and cystogram; 30% had VUR, 50% of which had an altered US and 57% had renal scars on the DMSA scan. 12% of the children had an altered US with a cystogram showing no VUR; 66% of these had renal scars. 4% had vesical anomalies on the US and cystogram.
Conclusion:
The three exams chosen were able to direct the diagnostic approach of UTI, being sufficient in most of the cases. We would like to emphasize the importance of the DMSA scan in diagnosing unsuspected renal scars.