Urinary tract imaging in infancy

The Pediatric Kidney

“…• All these amounts to the evident necessity for specifi cally trained and experienced pediatric (uro)radiologists, child adapted environment and equipment, as well as different scheduling of investigations when imaging the child's urinary tract. Some basic procedural recommendations concerning the proper use of imaging in pediatric uroradiology have been published (Riccabona et al 2008a(Riccabona et al , 2009Darge et al 2011 ). The proper use of renal scintigraphy in children has been outlined by European Association of Nuclear Medicine (Mandell et al 1997 ;Piepsz 2002 ;Gordon et al 2006;Piepsz and Ham 2006 ;Gordon 2008 ).…”

“…need further assessment (Alton et al 1992 ;Sorantin et al 1997 ;Riccabona et al 2008a ). Note that high-grade hydronephrosis is usually associated with obstructive uropathy, posterior urethral valve, or severe vesicoureteral refl ux -in some of these patients, an early urinary tract infection may have devastating effects justifying early diagnosis by comprehensive US and VCUG (Riccabona et al 2008a(Riccabona et al , 2009 ). Renal scintigraphy can be used to estimate residual renal function early in the most severe cases; otherwise, scintigraphy or MRU should always be postponed until at least after the sixth week of life, better the third month of life, as the immature kidney will not provide reliable results (Gordon and Riccabona 2003 ).…”

“…The main messages of these recommendations are: -US : Use high-resolution (linear) high-frequency transducers; always perform a comprehensive study of the entire urinary tract and renal parenchyma in well-hydrated patients including a postvoid assess-ment (Riccabona et al 2008a ). Try to exploit the potential of modern techniques such as (amplitudecoded) color Doppler US or harmonic imaging (Riccabona et al 2001 ;Bartram and Darge 2005 ;Riccabona 2002bRiccabona , 2009. Always use volume calculations and age-related growth charts -kidney length measurements are less reliable in children (Riccabona et al 2002b , c ).…”

“…It is easily available, nonirradiating, relatively inexpensive, and quite reliable if performed with professional skills by specifi cally trained, experienced, and knowledgeable investigators. US always includes the assessment of the entire well-hydrated urinary tract; an additional "sonoscopic" overview of the entire abdomen for other potential reasons of the child's symptoms is recommended (Riccabona et al 2008a ;Riccabona 2009 ). The aim of this initial US investigation in urinary tract infection is to fi nd signs that enable the differentiation of "upper" from "lower" urinary tract infection, to detect potentially undiagnosed preexisting urinary tract malformations early, to search for potential complications such as abscess formation or pyonephrosis, or to depict unusual disease such as infected urolithiasis or xanthogranulomatous pyelonephritis.…”

Urinary Tract Infection in Children

“…In order to facilitate the diagnosis and treatment decision, the differentiation of upper urinary tract infection including kidney or ureter between lower urinary tract including bladder or urethra should be conducted based on the clinical symptoms and signs. Although the prediction rate of US for abnormalities has been questioned (Zamir, Sakran et al 2004;Riccabona and Fotter 2009), notwithstanding, many congenital abnormalities of urinary tract have currently been detected by prenatal sonography. US is still considered an ideal tool to examine the urinary tract for children with first UTI for its noninvasiveness, reproducibility and lack of radiation exposure.…”