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[Study of children with urinary tract infections. Does intravenous urography play any role?]
A Hansen1, A Wagner, L D Lavard
1Børneafdelingen, radiologisk afdeling, Hvidovre Hospital.
Insights
Intravenous urography (IVU) is a valuable tool for diagnosing urinary tract infections (UTI) in children. It complements ultrasonography (US) and dimercaptosuccinic acid scans (DMSA), especially for detecting renal scarring and guiding treatment.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTI) are common in children and require accurate diagnosis.
- Current diagnostic approaches include ultrasonography (US) and 99m-Tc dimercaptosuccinic acid scans (DMSA).
- The role of intravenous urography (IVU) in conjunction with these modalities needs further clarification.
Purpose of the Study:
- To evaluate the diagnostic yield of IVU compared to US and DMSA in children with UTI.
- To determine the added value of IVU in identifying significant findings relevant to treatment and prognosis.
- To establish guidelines for the appropriate use of IVU in pediatric UTI investigations.
Main Methods:
- Ninety children with UTI underwent IVU, US, and DMSA scans.
- Fifty-eight children also had micturition cystourethrography (MCU).
- Abnormal findings from each imaging modality were recorded and analyzed.
Main Results:
- Abnormal results were observed in 36% of children.
- IVU showed abnormalities in 29 children, US in 10, and DMSA in 16.
- IVU identified important findings in 10 children where other scans were normal, including cases of vesicoureteric reflux.
Conclusions:
- IVU remains an important supplement to US and DMSA in the investigation of pediatric UTIs.
- IVU is particularly useful for detecting renal scarring or dilatation and in cases of recurrent infections.
- Consideration should be given to performing IVU in specific pediatric UTI scenarios.
Abstract:
Ninety children referred to hospital with urinary tract infections (UTI) were investigated by intravenous urography (IVU), ultrasonography (US) and 99m-Tc dimercaptosuccinic acid scan (DMSA). Fifty-eight children also had a micturition cystourethrography performed. In 36 (40%) of the children at least one result was abnormal. In 29 children IVU was abnormal, 10 had abnormal US and 16 had abnormal DMSA. Six of the 58 children had vesicoureteric reflux in eight kidneys. In 16 children IVU was the only examination with an abnormal result, and in ten of these the findings were considered important for treatment or prognosis. In conclusion, IVU is an important supplement to US and DMSA in investigation programs for children with UTI. IVU should be performed in cases of renal scarring or dilatation and in children with recurrent infections.