Ultrasound in Hospitalized Children With First Febrile UTI: What Exactly Are We Looking For?

Abstract

Detection of genitourinary abnormalities and vesicoureteral reflux (VUR) in young children who present with a febrile urinary tract infection (UTI) is important because severe VUR may predispose to renal scar formation, which may lead to hypertension and impaired kidney function. In this issue of Hospital Pediatrics , Wallace et al1 attempt to identify clinical factors that could be used to predict which hospitalized children 0 to 24 months of age with first febrile UTI are likely to have an abnormal renal bladder ultrasound (RBUS). The authors were not able to determine any clinical factors (other than known genitourinary tract abnormalities) that could be used to guide selective RBUS screening. The authors conclude that selective screening cannot be applied and recommend screening all young children at the time of first febrile UTI. Screening for genitourinary abnormalities technically precedes UTI in most children because severe genitourinary abnormalities and clinically significant hydronephrosis may be noted on a prenatal ultrasound. One study of 4586 children revealed that a prenatal ultrasound identified severe genitourinary tract abnormalities requiring immediate intervention with a negative predictive value of 99.9%.2 In a prescreened population, we would not expect an ultrasound at the time of first UTI to detect prenatally missed posterior urethral valves or high-grade obstruction. The population in this study was a prescreened population in which all patients had a normal prenatal ultrasound, and all patients with …