Abstract
Urinary tract infections (UTIs) are common amongst children and invariably result in imaging tests to look for correctable causes that may predispose the child to infection. The objective of imaging is to identify those children at risk of long-term renal damage. The ideal imaging algorithm is extensively debated in the literature owing to the lack of evidence-based data, evolving theories on the pathophysiology of UTI and vesicoureteric reflux (VUR). The present article provides a case-based approach to the imaging of UTIs and proposes guidelines relevant to the South African setting.
Highlights
7%–8% of girls and 2% of boys have a urinary tract infection (UTI) within the first 8 years of life, with the highest incidence within the first year in both sexes.[1]
Historic management of UTI has been based on the premise that recurrent UTIs, with vesicoureteric reflux (VUR), increase the risk of chronic kidney disease, hypertension and end-stage renal disease
The National Institute for Health and Clinical Excellence (NICE) altered guidelines in the UK in 2007 and the AAP (American Academy of Pediatrics) in 2011, both of which recommended radically reducing the use of imaging, fluoroscopy and nuclear medicine, in the setting of a first typical UTI.[4,5]
Summary
7%–8% of girls and 2% of boys have a urinary tract infection (UTI) within the first 8 years of life, with the highest incidence within the first year in both sexes.[1]. The preceding renogram provides additional information about renal function and cortical defects.[10] The disadvantage is reduced anatomic resolution and no imaging of the urethra.[19] A RNC study should be considered in girls as urethral pathology is less common, in boys older than 2 years in whom posterior urethral valves are not suspected, and in follow-up studies assessing for resolution of VUR. Direct RNC requires urethral catheterisation and direct installation of tracer It is more sensitive than MCUG in detecting reflux at a reduced dose; it is not widely used as it lacks high spatial resolution and does not have the advantage of the functional assessment provided by the indirect study.[20]. The benefits of MRI and the lack of radiation remain offset by the sedation needed for the lengthy examinations, the cost of the procedure and lack of access to the study by the vast majority of patients undergoing investigation for UTI
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