Pediatric UrologyRenal Ultrasonography Should Be Done Routinely in Children with First Urinary Tract Infections
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.
References (28)
Vesicoureteral reflux and renal injury
Am J Kidney Dis
(1991)- et al.
Does urinary tract ultrasonography at hospitalization for acute pyelonephritis predict vesicoureteral reflux?
J Urol
(2001) - et al.
Renal sonography is not a reliable screening examination for vesicoureteral reflux
J Urol
(1993) - et al.
Detection and management of the dilated fetal urinary tract
Clin Radiol
(1989) - et al.
Urinary tract anomalies detected by prenatal ultrasound examination at Mayo Clinic Rochester
Mayo Clin Proc
(1995) - et al.
Timing of voiding cystourethrogram in the investigation of urinary tract infections in children
J Pediatr
(2001) - et al.
Antibiotics for the prevention of urinary tract infection in children: a systemic review of randomized controlled trials
J Pediatr
(2001) - et al.
Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age
Acta Paediatr
(1998) - et al.
A single pediatric center experience with 1025 children with hypertension
Acta Paediatr
(1992) - et al.
Renal scarring after acute pyelonephritis
Arch Dis Child
(1994)