Ces radiol. 2013, 67(4):253-259

Urinary tract imaging in children with in febrile urinary tract infection in the age of 12-24 months in tertiary care center in Czech Republic: discussing the current aproachOriginal article

Eliška Mlynářová1, Jakub Zieg2, Erich Sorantin3
1 Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha
2 Pediatrická klinika 2. LF UK a FN Motol, Praha
3 Department of Radiology, Division of Pediatric Radiology, University hospital Graz, Austria

Aim: Ultrasound investigation and voiding cystouretrography (VCUG) are part of the diagnostic algorithm in children with febrile urinary tract infection (UTI) with the aim of depicting any complication of the infection and underlying anomalies of the urinary tract. As the understanding of the relationship between UTI, renal scarring and vesicoureteral reflux (VUR) evolves, new recommended imaging algorithms are being introduced.

Methods: 184 patients that underwent VCUG after the first or recurrent febrile UTI were included in the study. The incidence of VUR in both groups have been evaluated and compared with ultrasound findings. Patients with VUR were divided into those with non-dilating (VUR grade I-II) and dilating (VUR grade III-V) reflux.

Results: Overall VUR was diagnosed in 39/184 (21%) patients. VUR was seen in 23/156 (15%) patients in the group of patients after the first fibrile UTI, in comparison to 16/28 (57%) patients with recurrent fibrile UTI (statistically significant difference, p < 0,0001). 8/156 (5%) patients after the first febrile UTI had dilating VUR, compared to 11/28 (39%) patients after recurrent febrile UTI (statistically significant difference, p < 0,0001).

Conclusion: In compliance with current recommendations of the American Academy of Paediatrics the results of this study have shown low incidence of VUR and dilating VUR in patients with a history of single febrile UTI. Based on the results of our study it can be concluded that VCUG is not recommended in all patiens in the age of 2-24 months but only in specifically identified cases.

Keywords: child, urinary tract infections, ultrasonography, vesicoureteral reflux, radiography

Accepted: September 15, 2013; Published: December 1, 2013  Show citation

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Mlynářová E, Zieg J, Sorantin E. Urinary tract imaging in children with in febrile urinary tract infection in the age of 12-24 months in tertiary care center in Czech Republic: discussing the current aproach. Ces radiol. 2013;67(4):253-259.
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    References

    1. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. The Pediatric infectious disease journal 2008; 27(4): 302-308. Go to original source... Go to PubMed...
    2. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging Studies after a First Febrile Urinary Tract Infection in Young Children. N Engl J Med 2003; 348(3): 195-202. Go to original source... Go to PubMed...
    3. Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 2010; 126(6): 1084-1091. Go to original source... Go to PubMed...
    4. Pecile P, Miorin E, Romanello C, et al. Age-related renal parenchymal lesions in children with first febrile urinary tract infections. Pediatrics 2009; 124(1): 23-29. Go to original source... Go to PubMed...
    5. Roberts KB, Downs SM, Finnell SME, et al. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011; 128(3): 595-610. Go to original source... Go to PubMed...
    6. Mattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis 2011; 18(5): 348-354. Go to original source... Go to PubMed...
    7. Fidan K, Kandur Y, Buyukkaragoz B, Akdemir UO, Soylemezoglu O. Hypertension in pediatric patients with renal scarring in association with vesicoureteral reflux. Urology 2013; 81(1): 173-177. Go to original source... Go to PubMed...
    8. Jacobson SH, Eklof O, Eriksson CG, et al. Development of hypertension and uraemia after pyelonephritis in. BMJ 1989; 299: 703-706. Go to original source... Go to PubMed...
    9. Moorthy I, Easty M, McHugh K, et al. The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Archives of disease in childhood 2005; 90(7): 733-736. Go to original source... Go to PubMed...
    10. Orellana P, Baquedano P, Eng NDC, et al. Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project. Pediatr Nephrol 2004; 19(10): 1122-1126. Go to original source... Go to PubMed...
    11. National Institute for Health and Care Excellence. Urinary tract infection in children: Diagnosis, treatment and long-term management. London 2007; CG54.
    12. Riccabona M, Avni FE, Blickman JG, et al. Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 2008; 38(2): 138-145. Go to original source... Go to PubMed...
    13. Janda J, Bébrová E. Návrh doporučených postupů při diagnostice infekce močových cest u dětí (IMC). Mikrobiologická diagnostika. Pracovní dny dětské nefrologie, 34th Annual Meeting of the Czech Working Group for Pediatric Nephrology.
    14. Hrodek O, Vavřinec J, et al. Pediatrie. Praha: Galén 2002; 312-314.
    15. Schaeffer HA, Hardy DR, Jewett PH, et al. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Paediatrics 1999; 103: 843-1052. Go to original source... Go to PubMed...
    16. Fotter R, Avni EF. Pediatric uroradiology. Berlin Heidelgerg: Springer 2001. Go to original source...
    17. Agrawalla S, Pearce R, Goodman TR. How to perform the perfect voiding cystourethrogram. Pediatr Radiol 2004; 34(2): 114-119. Go to original source... Go to PubMed...
    18. Teplan V, Horáčková M, Bébová E, Janda J. Infekce ledvin a močových cest v dospělém a dětském věku. Praha: Grada Publishing 2004; 106.
    19. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. Internation system of radiographic grading of vesicoureteric reflux Internation Reflux Study in Children. Pediatr Radiol 1985; 15(2): 105-109. Go to original source... Go to PubMed...
    20. Smellie JM, Poulton A, Prescod NP. Retrospective study of children with renal scarring associated with reflux and urinary infection. BMJ 1994; 308(6938): 1193-1196. Go to original source... Go to PubMed...
    21. Koyle M, Elder JS, Skoog SJ, Mattoo TK, Pohl HG, Reddy PP, et al. Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediat Surgy Int 2011; 27(4): 337-346. Go to original source... Go to PubMed...
    22. Riccabona M, Fotter R. Urinary tract infection in infants and children: an update with special regard to the changing role of reflux. Eur Radiol 2004; 14(Suppl 4): L78-88. Go to original source... Go to PubMed...
    23. Assael BM, Guez S, Marra G, et al. Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally. British journal of urology 1998; 82(2): 252-257. Go to original source... Go to PubMed...
    24. Montini G, Hewitt I. Urinary tract infections: to prophylaxis or not to prophylaxis? Pediatr Nephrol 2009; 24(9): 1605-1609. Go to original source... Go to PubMed...
    25. Brandström P, Esbjörner E, Herthelius M, et al. The Swedish Reflux Trial in Children: III. Urinary Tract Infection Pattern. J Urol 2010; 184: 286-291. Go to original source... Go to PubMed...
    26. Riccabona M. Cystography in infants and children: a critical appraisal of the many forms with special regard to voiding cystourethrography. Eur Radiol 2002; 12(12): 2910-2918. Go to original source... Go to PubMed...
    27. Gleeson FV, Gordon I. Imaging in urinary tract infection. Archives of disease in childhood 1991; 66: 1282-1283. Go to original source... Go to PubMed...
    28. Andrich MP, Massoud M. Diagnostic imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatrics 1992; 90(3): 436-441. Go to original source...
    29. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the society for fetal urology. Pediatr Radiol 1993; 23(6): 478-480. Go to original source... Go to PubMed...
    30. Massanyi EZ, Preece J, Gupta A, Lin SM, Wang MH. Utility of Screening Ultrasound After First Febrile UTI Among Patients With Clinically Significant Vesicoureteral Reflux. Urology 2013; 14: 1-5. Go to original source... Go to PubMed...
    31. Li PS, Ma LC, Wong SN. Is bag urine culture useful in monitoring urinary tract infection in infants? Journal of Paediatrics and Child Health 2002; 38(4): 377-381. Go to original source... Go to PubMed...
    32. Etoubleau C, Reveret M, Brouet D, et al. Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. J Pediatr 2009; 154(6): 803-806. Go to original source... Go to PubMed...
    33. Polito C, Moggio G, La Manna A, Al E. Cyclic voiding cystourethrography in the diagnosis of occult vesicoureteric reflux. Pediatr Nephrol 2000; 14(1): 39-41. Go to original source... Go to PubMed...
    34. Jequier J-C, Jequier S. Reliability of Voiding Cystourethrography to Detect Reflux. AJR 1989; 153: 807-810. Go to original source... Go to PubMed...

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