Controversies in the radiological investigation of paediatric urinary tract infection

Abstract

Parenchymal damage dictates the fate of the kidney and subsequent morbidity.Early antibiotic treatment prevents renal damage.Most infections are due to E. coli from an ascending infection.Micturating cystourethrography (MCU) alone is a poor detector of reflux and should now be replaced selectively by direct radionuclide cystography (DRC) ± MCU, which in combination identify more cases of reflux than a single examination.Voiding dysfunction should receive at least as much attention as reflux.Ultrasound should be studied further to increase its sensitivity for reflux in order to decrease the need for procedures using radiation.In future MRI may become the most informative imaging modality for the investigation of the urinary tract.99Tcm dimercaptosuccinic acid (DMSA) renal scintigraphy in the context of acute infection is sensitive but of unknown value.