Imaging Profile of Children Birth to 12 Years Presenting With First Urinary Tract Infection (Uti) at a Tertiary Care Hospital

Abstract

ABSTRACT:Imaging of the urinary tract is recommended for all children with UTI. The aim of these investigations is to identify patients at risk of renal damage, mainly those below 5years of age, with vesicoureteric reflux (VUR) or urinary tract obstruction. This study was designed and conducted in the department of Pediatrics and department of Radiodiagnosis, BVDU Medical college hospital, Pune during the period from July 2009 to August 2011 to do imaging studies as per protocol of investigations suggested by the Indian Pediatric Nephrology Group of children from birth to 12 years of age presenting with their first culture positive UTI who attended our tertiary care centre. Abnormal USG was found in 40.3% cases and helped to identify hydroureteronephrosis (HUN) and calculi. Micturating cystourethrography (MCU) examination was abnormal in 31.1% cases. Of which, 22.2% patients had VUR suggesting that VUR is common in culture positive UTI, thus stressing the need of MCU in patients of culture positive UTI. DMSA scintigraphy (DMSA) showed scar in 56% of total cases examined indicating need for doing DMSA whenever indicated and for prognostication. One single imaging modality is not sufficient to evaluate children with UTI. HOW TO CITE THIS ARTICLE: INDRODUCTION: Urinary tract infection (UTI) is a commoninfection in infants and children. Rapid evaluation and treatment of UTI is important to prevent renal parenchymal damage (Renal scarring) that can cause hypertension, toxaemia of pregnancy, chronic renal failure and end-stagerenal disease later. Risk factors for renal scarring include: young age especially children less than one year old, delay in initiating antibacterial treatment, recurrent UTI, and presence of moderate to severe VUR. (1,2) Imaging of the urinary tract is recommended for all children with UTI. The aim of these investigations is to identify patients at risk of renal damage, mainly those below 5years of age, with VUR or urinary tract obstruction. The following is the protocol of investigations suggested by the Indian Pediatric Nephrology Group in the consensus statement on management of urinary tract infection. (2) 20% of children with urinary tract infections have an underlying structural abnormality of the urinary tract, three-fourth of which are picked up on ultrasound. In addition, a micturating cystourethrography (MCU) is also indicated in all boys below 2 years with UTI, since one-third of anomalies will be missed if only ultrasound is done. (3,4,5) In one study VUR was identified in 106 of 171 kidney units when MCU was done following the first UTI. (6) DMSA renal scan is the best mode for evaluation of renal parenchymal involvement. During the acute infection it can detect focal pyelonephritis and later show renal scars.