Urography In Children Research Articles

Simplifying excretory urography in children with urinary tract infection

Simplifying excretory urography in children with urinary tract infection

Comparison of 99Tcm dimercaptosuccinic acid scans and intravenous urography in children

A retrospective comparison of 99Tcm dimercaptosuccinic acid (DMSA) scans and intravenous urograms (IVUs) was performed on a large, unselected paediatric population to assess critically the relative merits of these two techniques. A total of 205 children were studied, providing 388 kidneys for comparison. The studies agreed in 81%, both being normal in 39%, and both abnormal in 42%. In 28 kidneys (7%), the IVU was abnormal when the 99Tcm DMSA was normal. There was a collecting system abnormality in 27 kidneys, but 10 kidneys also showed a parenchymal abnormality. In all these the parenchymal abnormality was global thinning on the IVU, and the contralateral kidney was small. In 40 kidneys (10%) the 99Tcm DMSA was abnormal when the IVU was normal: the abnormalities demonstrated were predominantly focal defects. After excluding IVUs of poor diagnostic quality, only 14 kidneys (3.6%) showed this disparity. The important clinical subgroups are infection, with or without reflux (27 kidneys), hypertension (4) and neonates with poor renal function (2). The one false positive 99Tcm DMSA was a result of an anatomical variant. Global thinning in a "normal" kidney on a 99Tcm DMSA scan may be overlooked when the contralateral kidney is poorly functioning and small.

Intravenous urography in children and youth.

This report derives from Tromsoe in northern Norway. In a retrospective study of the indications for intravenous urography (IU) and the findings at IU in 740 patients (451 girls and 289 boys) aged 0-19 years, we found that urinary tract infections accounted for 69.4% of the IU in females 30.1% of the IU in males, most often seen in the youngest patients. The pathological findings most frequently seen were anomalies (17 females and 10 males) and urinary tract obstruction (3 females and 15 males). The present study indicates the following: first, that the yield of IU in the primary investigation of children and youth suffering from enuresis and non-specific abdominal disturbancies is small; and second, that the use of IU in children and youth with urinary tract infection and haematuria should be questioned and reconsidered.

Ureteral dilatation in children with febrile urinary tract infection or bacteriuria.

Little information is available on the relationship between urinary infection in children and infants, with or without vesicoureteral reflux, and dilatation of the urinary tract. The purpose of this study was to determine the effects of infection and reflux on the diameter of the ureter at excretory urography in children with acute, febrile urinary tract infections and in infants with bacteriuria found at screening. Standardized measurements of ureteral diameter were obtained for 79 children (2 months to 6 years old) with urinary tract infections and for 45 infants with bacteriuria. Patients with urinary tract obstruction or malformations were excluded. Seventy-one children with febrile urinary tract infection had ureteral visualization that allowed measurements. Ureteral diameter in this group was significantly wider than in a reference group, and 42 children (59%) had ureteral diameters that were more than 2 standard deviations above the normal mean. Ureteral diameter at excretory urography increased with increasing grades of reflux, but dilatation occurred also in the absence of reflux. Twenty-two of the 45 infants in the group with bacteriuria had sufficient ureteral visualization for measurements. The ureters in this group were wider than in the reference group, and eight infants had ureteral diameters that were more than 2 standard deviations above the normal mean. We conclude that ureteral dilatation is a common effect of acute urinary tract infection and bacteriuria in children.

Sonography as a substitute for excretory urography in children with urinary tract infection.

The possibility was explored of substituting renal sonography for excretory urography in children with urinary tract infection. Seventy-one patients were studied prospectively with voiding cystourethrography, sonography, and excretory urography; each examination was reviewed independently and without knowledge of the results of the others. Compared with urography the sensitivity and specificity of sonography was 100% and 51%, respectively, provided sonograms were of good technical quality. In a few instances, however, focal renal parenchymal scars were clearly seen only on urography. The findings suggest that in the absence of vesicoureteral reflux children with urinary tract infection should be studied with sonography. No further study is needed if a good-quality sonogram is within normal limits. In the presence of vesicoureteral reflux, however, or a suspicious or abnormal sonogram, excretory urography appears to be still necessary, at least at the present level of knowledge and technical expertise.

Urography in children: when should it be done? 2. Conditions other than infection.

Conditions that are often associated with an increased incidence of renal anomalies include imperforate anus, congenital vertebral abnormalities, and Fanconi anemia; excretory urography should be done if such a condition is present. Urography is also useful to provide baseline data in conditions associated with later development of urinary problems, such as myelodysplasia, prune-belly syndrome, and exstrophy of the bladder. In addition, urography serves as a periodic check for complications of treatment (hydronephrosis, obstruction) in patients with urinary diversion. Certain signs, eg, dribbling, hematuria after mild trauma, unexplained pneumothorax or pneumomediastinum in a neonate, and neonatal abdominal mass, call for immediate urography. In many conditions that were formerly thought to be associated with major urinary abnormalities, urography is not called for. Such is the case in hypospadias, deformities of the external ear alone, and undescended testes. Dehydration is the only absolute contraindication to urography.

Urography in children: when should it be done? 1. Infection.

Radiologic evaluation of urinary tract infection in children should include both excretory urography and voiding cystourethrography. Excretory urography is done to search for anomalies predisposing to infection and for signs of previous episodes of pyelonephritis or reflux and to serve as a baseline for future studies. Voiding cystourethrography is done to search for abnormalities in the natural barriers that protect the renal medulla from infection. If reflux is found to be present and sequential reflux studies are done, they should be performed by the radionuclide method to observe changes in degree or cessation.

Large dose urography in children.

Large dose urography in children.

Hyaluronidase as an agent facilitating intramuscular urography in children.

Acta PaediatricaVolume 40, Issue S83 p. 124-125 Hyaluronidase as an agent facilitating intramuscular urography in children Erik Jacobsson, Erik Jacobsson SwedenSearch for more papers by this authorHerman Gladnikoff, Herman Gladnikoff SwedenSearch for more papers by this author Erik Jacobsson, Erik Jacobsson SwedenSearch for more papers by this authorHerman Gladnikoff, Herman Gladnikoff SwedenSearch for more papers by this author First published: December 1951 https://doi.org/10.1111/j.1651-2227.1951.tb04624.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume40, IssueS83December 1951Pages 124-125 RelatedInformation

Proceedings of the Section for Pediatrics and School Hygiene of the Swedish Medical Society

Bo Hellström and Bo Vahlquist: Experimental inoculation of exanthema subitum. Yngve Larsson: Treatment of diabetes with insulin mixtures. H. Enell: A follow‐up examination of Calmette vaccinated children. A. Hellslröm and K. A. Melirn: Glutamine acid treatment in cases of mental retardation. G. Ekström: Follow‐up examination of cases of patent ductus arteriosus operated upon in Stockholm. R. Krämer: Pulmonary stenosis with auricular septal defect. Th. Ehrenpreis: New aspects on the pathogenesis and treatment of the megacolon. Chr. Lingen: A demonstration of an apparatus for electrophoresis. Erik Jacobsson and Herman Gladnikoff: Hyaluronidase as an aid to urography in children. I. Bjelkhagen, H. Kristiansen and Y. Lindblad: Retrolental fibro‐plasia: Follow‐up examination of babies born between 1940 and 1949. S. Jorup and E. Bergquist: The percutaneous tuberculin reaction (patch test) in relation to BCG vaccination. Arne Hultman: Antibiotic treatment of sinusitis in children.

Intravenous Urography in Children

THE pediatrician not infrequently is called upon to determine the cause of an obscure fever, a persistant pyuria or to diagnose the nature of an abdominal mass. There mayor may not be outspoken accompanying urinary symptoms and signs, as in carbuncle of the kidney or in certain types of hydronephrosis. Furthermore, the symptoms and signs may be predominantly of a non-urinary nature. Because of inherent difficulties and inconveniences which may be associated with cystoscopy and retrograde pyelography in children, the physician has been inclined frequently to dispose of a case of pyuria with the diagnosis of pyelitis, or to perforce remain in the dark regarding the origin of an obscure fever. Under these circumstances excretion urography has been of considerable help both for diagnosis and as a survey study. This is particularly so when retrograde pyelography may be at times mechanically impossible, taxing, or dangerous. As a result, the status of the urinary tract in general, and congenital anomalies in pa...