Practice guidelines from the Americ...

Practice guidelines from the American Academy of Pediatrics make acceptable renal ultrasonography and voiding cystourethrography (VCUG) in all children sum of two units months to two years of age with a documented first urinary tract infection (UTI). Other authorities have give an inkling ofed using renal scanning with technetium 99m at the acute infection and later to discover evidence of renal scarring. Hoberman and colleagues directioned a prospective trial to determine if imaging studies in young children with a first UTI altered management or improved outcomes

This multicenter trial initially listed 421 children who were the same to 24 months of age and had a agitation and pyuria or bacteriuria in a catheterized urine specimen. Final application of mind results were calculated for 309 children (73 percent) after excluding those with negative urine refinements declined consent, or other logistical barriers to participation. Each child received renal ultrasonography and technetium 99m renal scanning within 48 hours of the initial diagnosis of UTI. VCUG was performed in 98 percent of the enslaves one month after the infection, and follow-up renal scanning was performed in 89 percent of the enthralls six months after diagnosis to discover any renal scarring. Children with at least grade II vesicoureteral ebb received either trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin one time daily for 11 months or until the ebb was classified as grade I or less

The initial renal sonogram was normal in 88 percent of the children with UTI. The personality of hydroureter on ultrasonography was not a sensitive defence for urine reflux, identifying solely 10 percent of children who had ebb that was later confirmed by the agency of VCUG. No child had a change in clinical management based in succession renal sonography.

Nuclear medicine renal scanning identified acute pyelonephritis in 61 percent of children with UTI. At six month of follow-up repeat renal scanning identified scarring in 95 percent of children. Scarring was more likely in the subgroup of patients with initial evidence of vesicoureteral ebb (15 percent scar rate) than in those without vesicoureteral ebb (6 percent scar rate). No child with an initially normal renal scan had scarring forward the six-month follow-up scan.

VCUG demonstrated ebb of urine in 39 percent of children. solely 4 percent of children had ebb above grade III.

The authors decide that results of initial renal sonography and nuclear medicine scanning are not likely to alter management in young children with UTI. The authors advocate obtaining a urinalysis and urine civilization to identify any recurrence of infection in following febrile episodes in a child with a documented UTI.

Hoberman A, et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J M January 16 2003;348:195-202

COPYRIGHT 2003 American Academy of Family Physicians

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