Abstract
A retrospective cross-sectional study conducted at Mediclinic City Hospital; a teaching hospital in collaboration with Mohammad Bin Rashid University for Medicine and health sciences in Dubai, United Arab Emirates (UAE). The aim of this study is to ascertain conduction of renal radio nuclear investigations, explicitly Kidney ureter bladder ultrasound scans (KUB US), Micturating cystourethrogram (MCUG), and Dimercaptosuccinicacid (DMSA) in children following Urinary Tract Infection (UTI), based on; age, type of UTI, and recurrence. Medical records of 421 patients aged 0-16 years with UTI were retrospectively studied. Sociodemographic variables were age, gender, type of UTI, and recurrence. Results showed that the most carried out investigation was KUB US (38.2%) (n=161). In children aged between 7 months and 3 years, 15% (n=8) of them had VUR or renal scarring, while only12% (n=11) of children aged > 3 years showed abnormal MCUG or DMSA regardless of the KUB US results. Interestingly more than half (56%) (n=236) of all patients (n=421) with recurrent UTI showed abnormalities by MCUG and or DMSA, while only 12.3% (n=14) of children with atypical UTI showed abnormalities. It is concluded that VUR and renal scarring predominantly occurred in patients with recurrent UTI and atypical UTI. Thus, children presenting with recurrent UTI are recommended to undergo MCUG and DMSA after the second recurrent episode rather than waiting for the third UTI incident. This study suggests that children aged 7 months to 3 years post UTI should undergo KUB US, MCUG (if it was a recurring UTI) plus DMSA or MAG3 with post-micturition study instead. Children older than 3 years presenting with recurrent UTI are recommended to undergo DMSA (regardless of the US results) and MAG3 with post-micturition study or MCUG especially if DMSA is abnormal. Keeping in mind, evaluating risk factors like family and past medical history are crucial before conducting any investigation, this is to avoid unnecessary scans, and at the same time implement measures to reduce risks resulting from complicated UTIs.
Highlights
Radio-nuclear investigations following Urinary Tract Infection (UTI) in children remains a controversial topic
Total number of patients presented with recurrent UTI was 7.2% (n=30), in which 20 cases (66.7%) were above 3 years, and the other 10 cases (33.3%) were aged 7 months to 3 years. (Figure 3)
This study showed that recurrent and atypical UTI are at high risks of developing complications, children of all ages with recurrent or atypical UTI are recommended to be investigated early
Summary
Radio-nuclear investigations following UTI in children remains a controversial topic. There is no consensus of when to perform DMSA and MCUG scans. Urinary tract infection (UTI) is one of the most common bacterial infections encountered in childhood [1]. Classical UTI is of no serious consequences if detected and treated early, some consequences can be lifelong if the infection is associated with other urinary tract abnormalities such as: VUR, recurrent infections, atypical infections or complicated UTI [2]. If not properly detected or treated, consequences such as hypertension, kidney dysfunction, renal scarring, and other complications could be life-threatening [3].
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