Is ultrasonography mandatory in all children at their first febrile urinary tract infection?

Pennesi, Marco; Amoroso, Stefano; Pennesi, Giulia; Giangreco, Manuela; Cattaruzzi, Elisabetta; Pesce, Marco; Busetti, Marina; Barbi, Egidio; Conversano, Ester

doi:10.1007/s00467-020-04909-5

Cited by 9 publications

(17 citation statements)

References 26 publications

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“…Of the 29 included studies, 9 studies were published between 2000 and 2010, whereas 20 studies were published between 2011 and 2022 (Table). Nineteen studies were retrospective, and 10 studies were prospective cohorts.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 27 studies that reported sex, the median percentage of females was 40% (range, 20%-89%), and the median percentage of males was 60% (range, 11%-80%). Thirteen studies included pyuria in their UTI diagnostic criteria, and 23 studies defined abnormal ultrasonography results. The study sample size ranged from 66 to 820 children (median, 300 children).…”

Section: Resultsmentioning

confidence: 99%

“…The study sample size ranged from 66 to 820 children (median, 300 children). Of the 21 studies that reported the causative bacteria, Escherichia coli was the main causative bacteria (median, 86% [range, 67%-96%]). Fifteen of 25 studies that included data on kidney ultrasonography timing reported performing ultrasonography during the hospital admission or within a week after diagnosis of UTI.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies 46,50 did not report criteria for the diagnosis of UTI (eTable 4 in Supplement 1). Twenty-three studies 14,19,[29][30][31][32][33][34][35][36][37][39][40][41][42][43][44]48,[50][51][52][53][54] reported criteria for abnormalities seen on kidney ultrasonography, and 10 studies 19,29,32,37,38,41,42,46,48,51 reported criteria and/or a grading system for hydronephrosis, of which 6 studies 19,29,37,40,42,48 used the Society of Fetal Urology system (eTable 5 in Supplement 1). 56 No study reported a statistical analysis plan for prevalence with 95% CIs.…”

Section: Quality Assessmentmentioning

confidence: 99%

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Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

et al. 2023

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ImportanceControversy exists on the clinical utility of kidney ultrasonography after first febrile urinary tract infection (UTI), and clinical practice guideline recommendations vary.ObjectiveTo determine the prevalence of urinary tract abnormalities detected on kidney ultrasonography after the first febrile UTI in children.Data SourcesThe MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases were searched for articles published from January 1, 2000, to September 20, 2022.Study SelectionStudies of children with first febrile UTI reporting kidney ultrasonography findings.Data Extraction and SynthesisTwo reviewers independently screened titles, abstracts, and full texts for eligibility. Study characteristics and outcomes were extracted from each article. Data on the prevalence of kidney ultrasonography abnormalities were pooled using a random-effects model.Main Outcomes and MeasuresThe primary outcome was prevalence of urinary tract abnormalities and clinically important abnormalities (those that changed clinical management) detected on kidney ultrasonography. Secondary outcomes included the urinary tract abnormalities detected, surgical intervention, health care utilization, and parent-reported outcomes.ResultsTwenty-nine studies were included, with a total of 9170 children. Of the 27 studies that reported participant sex, the median percentage of males was 60% (range, 11%-80%). The prevalence of abnormalities detected on renal ultrasonography was 22.1% (95% CI, 16.8-27.9; I2 = 98%; 29 studies, all ages) and 21.9% (95% CI, 14.7-30.1; I2 = 98%; 15 studies, age &lt;24 months). The prevalence of clinically important abnormalities was 3.1% (95% CI, 0.3-8.1; I2 = 96%; 8 studies, all ages) and 4.5% (95% CI, 0.5-12.0; I2 = 97%; 5 studies, age &lt;24 months). Study recruitment bias was associated with a higher prevalence of abnormalities. The most common findings detected were hydronephrosis, pelviectasis, and dilated ureter. Urinary tract obstruction was identified in 0.4% (95% CI, 0.1-0.8; I2 = 59%; 12 studies), and surgical intervention occurred in 1.4% (95% CI, 0.5-2.7; I2 = 85%; 13 studies). One study reported health care utilization. No study reported parent-reported outcomes.Conclusions and RelevanceResults suggest that 1 in 4 to 5 children with first febrile UTI will have a urinary tract abnormality detected on kidney ultrasonography and 1 in 32 will have an abnormality that changes clinical management. Given the considerable study heterogeneity and lack of comprehensive outcome measurement, well-designed prospective longitudinal studies are needed to fully evaluate the clinical utility of kidney ultrasonography after first febrile UTI.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

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Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

et al. 2023

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“…The direct costs that would have been incurred for the different follow-up protocols [2,10] were calculated. The costing consisted of the reimbursement of Italian Health System: RUS (€82) [20], blood sample collection (€2.58), creatinine dosage (€1.13), urinalysis (€2.17), follow-up visit (€20.66) [21].…”

Section: Cost Analysismentioning

confidence: 99%

Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information

Guarino

Sessa

Riccio

et al. 2022

JCM

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We aimed to evaluate the prognostic value of renal length (RL) > 2 standard deviation scores (SDS) measured by renal ultrasound (RUS), across infancy, childhood and adolescence, in identifying which patients with congenital solitary functioning kidney (CSFK) are at lower risk of developing kidney injury (KI). We also estimated the cost saving of integrating the current follow-up protocols with an early RUS algorithm (ERUSA). Fifty-six CSFK adult patients who were 1–3 months old at first observation of undergoing RUS were enrolled. KI was defined by hypertension and/or proteinuria and/or declined renal function. ERUSA was assessed by early (at 1–3 months of life) RUS and was retrospectively tested in our patients. ERUSA establishes that patients with RL > 2SDS at early RUS do not undergo further follow-ups. The others undergo another RUS at 1 year of age along with follow-ups according with current protocols, with the exception of RUS which could be no longer performed. Direct and indirect costs were calculated for each analysed protocol and the cost saving of applying ERUSA was calculated. None of the patients with early RL > 2SDS presented KI in adulthood. A RL > 2SDS was predictive of absence of KI only at 1–3 months (OR = infinity) and 1 year of age (OR = 0.13; 95%CI: 0.03–0.66; p = 0.01). ERUSA provided a total cost-sparing ranging from 38.6% to 55.3% among the analysed follow-up protocols. With ERUSA, no patients developing KI in adulthood were missed. In conclusion, only a RL > 2SDS at 1–3 months and 1 year of age predicted good prognosis in young adulthood. ERUSA can guide a cost-sparing follow-up strategy in CSFK patients while maintaining important long-term information.

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Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review

Hewitt,

Roebuck,

Montini

2023

Pediatr Radiol

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Background A first febrile urinary tract infection (UTI) is a common condition in children, and pathways of management have evolved over time. Objective To determine the extent to which pediatricians and surgeons differ in their investigation and management of a first febrile UTI, and to evaluate the justifications for any divergence of approach. Materials and methods A literature search was conducted for papers addressing investigation and/or management following a first febrile UTI in children published between 2011 and 2021. Searches were conducted on Medline, Embase, and the Cochrane Controlled Trials Register. To be eligible for inclusion, a paper was required to provide recommendations on one or more of the following: ultrasound (US) and voiding cystourethrogram (VCUG), the need for continuous antibiotic prophylaxis and surgery when vesicoureteral reflux (VUR) was detected. The authorship required at least one pediatrician or surgeon. Authorship was categorized as medical, surgical, or combined. Results Pediatricians advocated less imaging and intervention and were more inclined to adopt a “watchful-waiting” approach, confident that any significant abnormality, grades IV–V VUR in particular, should be detected following a second febrile UTI. In contrast, surgeons were more likely to recommend imaging to detect VUR (p<0.00001), and antibiotic prophylaxis (p<0.001) and/or surgical correction (p=0.004) if it was detected, concerned that any delay in diagnosis and treatment could place the child at risk of kidney damage. Papers with combined authorship displayed intermediate results. Conclusion There are two distinct directions in the literature regarding the investigation of an uncomplicated first febrile UTI in a child. In general, when presented with a first febrile UTI in a child, physicians recommend fewer investigations and less treatment, in contrast to surgeons who advocate extensive investigation and aggressive intervention in the event that imaging detects an abnormality. This has the potential to confuse the carers of affected children.

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Is ultrasonography mandatory in all children at their first febrile urinary tract infection?

Cited by 9 publications

References 26 publications

Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children

Early Renal Ultrasound in Patients with Congenital Solitary Kidney Can Guide Follow-Up Strategy Reducing Costs While Keeping Long-Term Prognostic Information

Conflicting views of physicians and surgeons concerning pediatric urinary tract infection: a comparative review

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