Elsevier

Urology

Volume 71, Issue 3, March 2008, Pages 439-443
Urology

Pediatric Urology
Renal Ultrasonography Should Be Done Routinely in Children with First Urinary Tract Infections

https://doi.org/10.1016/j.urology.2007.10.049Get rights and content

Objectives

To assess the consequences of renal ultrasonography (RUS) in the treatment of children younger than 5 years of age with a first febrile urinary tract infection.

Methods

We retrospectively reviewed the results of imaging studies, including RUS, computed tomography, and voiding cystourethrography in children with a first febrile urinary tract infection during a 2-year period. Children with known urologic anomalies, other underlying diseases, or simultaneous combined illnesses were excluded. Children with nephromegaly were diagnosed with acute lobar nephronia by computed tomography.

Results

A total of 390 children were included in this study. Of the 390 children, 112 (28.7%) had abnormal RUS findings. The children with abnormal RUS findings of nephromegaly, small kidney, intermittent hydronephrosis, or a double collecting system had a significantly greater incidence of vesicoureteral reflux than children with normal RUS findings. Additionally, the occurrence of high-grade vesicoureteral reflux in children with abnormal RUS findings was more frequent than in children with normal RUS findings.

Conclusions

The results of our study indicate that it is worth performing RUS in children with a first febrile urinary tract infection because abnormal kidney size or other specific structural ultrasound findings should be investigated, in addition to isolated hydronephrosis.

Section snippets

Material and Methods

This retrospective study was conducted at the Department of Pediatrics of the National Taiwan University Hospital from June 2004 to May 2006. Children with known urologic anomalies, other underlying diseases, or simultaneous combined illnesses were excluded. All children included in the study were younger than 5 years and had been diagnosed with a first-time febrile UTI. UTI was defined as a positive urine monoculture (greater than 103 colony-forming units/mL in urine collected by suprapubic

Results

A total of 390 children were enrolled in this study during the testing period. Of the 390 RUS examinations, 278 (71.3%) were normal. The initial RUS findings are given in Table 1. The most frequent abnormal RUS finding was nephromegaly (11.8%). All children with a finding of nephromegaly underwent CT examinations and were diagnosed with ALN. Dilation of the pelvis and/or ureter was another frequent finding in our study group, and we subdivided it as follows: isolated hydronephrosis, hydroureter

Comment

We are in an era in which many urologic structural anomalies are detected by prenatal ultrasonography.12, 13 This is why no obvious structural anomalies, such as severe ureteropelvic junction obstruction, ureterovesical junction obstruction, or posterior urethral valve, were found in our study group. Also, the use of prenatal ultrasonography is the reason some physicians doubt the usefulness of RUS in children with a first febrile UTI. However, some less-severe structural anomalies, such as

Conclusions

We believe that routine RUS should be done in children with a first febrile UTI. Abnormal RUS findings, especially specific hydronephrosis and abnormal kidney size, are worth the extra time to disclose them, because they indicate a greater probability of VUR, and even high-grade VUR. Under these conditions, healthcare providers and families will have better information to determine whether VCUG is needed, because it is still an invasive study resulting in radiation exposure.

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