How to examine children with urinary tract infections?
Evidence for the value of routine urinary tract imaging techniques in infants after the first episode of urinary tract infections with febrile temperature is limited to modifying treatment or affecting prognosis.
The American Academy of Pediatrics recommends the use of routine urinary tract imaging (ultrasound and retrograde cystography) in infants after the first episode of urinary tract infection (UTI) that occurs with feverish temperature. However, according to the results of a prospective study published in the January issue of the New England Journal of Medicine, it turned out that there was no reason to conduct these methods. additional examination, as routine methods of visualizing the urinary tract rarely affect treatment changes. According to Dr. Alejandro Hoberman and colleagues (University of Pittsburgh, PA) of the study authors, urinary tract imaging methods are a standard examination in infants after the first episode of UTI with febrile temperature to diagnose d 'possible anomalies of the urinary tract, such as vesicourethral reflux, obstruction, ureterocele, acute inflammation of the renal parenchyma and nephrosclerosis, which predispose the development of the child from reinfection or unfavorable from a distance after action. Although urinary tract imaging techniques are used in everyday practice, there is limited evidence of their usefulness in modifying treatment or affecting the prognosis.
The results of the ultrasound performed during the first 72 hours after the diagnosis of UTI continuing with a feverish body temperature in 309 children from 1 month. up to 24 months of age, were normal in 272 children (88%), and the abnormalities revealed did not affect other therapeutic tactics in any child. Renoscintigraphy made it possible to diagnose acute pyelonephritis in 190 children (61%).
Using retrograde cystography, performed after 1 month. after the diagnosis of UTI, vesicourethral reflux was detected in 117/302 (39%) children, and 112/117 (96%) children had a degree I-III of reflux. Of the 275 children (89%) who underwent repeated renoscintigraphy after 6 months. after the diagnosis of UTI, nephrosclerosis was detected in 26 children (9.5%).
The authors believe that ultrasound in the exacerbation phase of the disease is of limited importance, while retrograde cystography for the detection of reflux is only important if AB prophylaxis reduces the frequency of reinfection and nephrosclerosis. General urine tests and bacteriological urine tests, performed in current practice, for the differential diagnosis of all feverish children suspected of urinary tract infection, make it possible to avoid additional examinations.
Dr. F. Bruder Stapleton (University of Washington, Seattle) confirms that retrograde cystography is the most important and perhaps the only urinary tract imaging technique presented to children in this age group with the first episode of d 'UTI with feverish body temperature.
Kidney ultrasound should always be performed for children with UTI who do not have effective antibiotic therapy, have a palpable abdominal mass, suspect urolithiasis or have been diagnosed with hydronephrosis according to the prenatal diagnosis.