Evaluation of Abnormal Radiological Findings in Children Under Five Years With Acute Pyelonephritis: A Retrospective Cohort Study
Journal of Pediatric Nephrology,
Vol. 10 No. 1 (2022),
20 April 2022
,
Page 23-31
https://doi.org/10.22037/jpn.v10i1.36606
Abstract
Background and Aim: Urinary tract infection is one of the most common infections in
childhood. The disease should not be overlooked because it has long-term complications such
as renal scarring and failure. We aimed to determine the relationships between radiological
findings in children under five years with acute pyelonephritis and its long-term complications.
Methods: In this retrospective study, we reviewed the medical records of all children
hospitalized with acute pyelonephritis in a two-year period. We studied, extracted, and
analyzed the imaging and demographic data of the patients.
Results: Out of 210 available cases, 54 children with acute culture-positive pyelonephritis
were included. All the included cases had undergone ultrasound, Radionuclide Cystogram
(RNC), Voiding Cystourethrography (VCUG) (for urinary reflux), and late DMSA
(Dimercaptosuccinic Acid) scintigraphy. We found that 46.2% had Vesicoureteral Reflux
(VUR), and 57.4% had an abnormal ultrasound, with hydronephrosis being the most
common finding (74.1%). We also found a significant correlation between ultrasound and
VUR (P=0.002). About 37% also had abnormal DMSA scintigraphy. However, in those with
normal ultrasound results, 20% suffered from VUR, with one being severe. Seven cases also
had abnormal DMSA scintigraphy.
Conclusion: We demonstrated that a normal urinary ultrasound does not rule out the
possibility of VUR or the risk of progression to renal parenchymal dysfunction and scarring.
Therefore, we suggest further utilizing the available radiologic techniques to diagnose and
minimize subsequent renal complications in the disease promptly.
- Pyelonephritis
- Urinary tract infections
- Kidney diseases
- Vesicoureteral reflux
- Ultrasonography
- Technetium Tc 99m dimercaptosuccinic acid
- Radionuclide imaging
How to Cite
References
Montini G, Tullus K, Hewitt I. Febrile urinary tract infections
in children. N Engl J Med. 2011; 365(3):239-50. [DOI:10.1056/
NEJMra1007755] [PMID]
Nelson WE. Nelson textbook of pediatrics. Amsterdam: Elsevier;
https://books.google.com/books?id=1BYtuwE
ACAAJ&dq=Nelson+textbook+of+pediatrics.+2020.&
Baumer JH, Jones RW. Urinary tract infection in children,
national institute for health and clinical excellence. Arch
Dis Child Educ Pract. 2007; 92(6):189-92. [DOI:10.1136/
adc.2007.130799] [PMID]
Ozen C, Ertan P, Aras F, Gumuser G, Ozkol M, Horasan
Dinc G. Evaluation of abnormal radiological findings in children
aged 2 to 36 months followed by recurrent urinary tract
infection: A retrospective study. Ren fail. 2017; 39(1):100-3.
[DOI:10.1080/0886022X.2016.1251460] [PMID] [PMCID]
Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and
management of urinary tract infection in children: Summary
of NICE guidance. BMJ. 2007; 335(7616):395-7. [DOI:10.1136/
bmj.39286.700891.AD] [PMID] [PMCID]
Subcommittee on urinary tract infection, steering committee
on quality improvement and management, Roberts KB.
Urinary tract infection: Clinical practice guideline for the diagnosis
and management of the initial UTI in febrile infants
and children 2 to 24 months. Pediatrics. 2011; 128(3):595-610.
[DOI:10.1542/peds.2011-1330] [PMID]
Cavagnaro F. [Urinary tract infection in childhood (Spanish)].
Rev Chilena Infectol. 2005; 22(2):161-8. [DOI:10.4067/
S0716-10182005000200007] [PMID]
Stogianni A, Nikolopoulos P, Oikonomou I, Gatzola M,
Balaris V, Farmakiotis D, et al. Childhood acute pyelonephritis:
Comparison of power doppler sonography and Tc-DMSA scintigraphy. Pediatr Radiol. 2007; 37(7):685-90.
[DOI:10.1007/s00247-007-0510-5] [PMID]
Bhatnagar V, Mitra DK, Agarwala S, Kumar R, Patel C, Malhotra
AK, et al. The role of DMSA scans in evaluation of the
correlation between urinary tract infection, vesicoureteric reflux,
and renal scarring. Pediatr Surg Int. 2002; 18(2-3):128-34.
[DOI:10.1007/s003830100680] [PMID]
Juliano TM, Stephany HA, Clayton DB, Thomas JC, Pope JC,
Adams MC, et al. Incidence of abnormal imaging and recurrent
pyelonephritis after first febrile urinary tract infection in
children 2 to 24 months old. J Urol. 2013; 190(4 Suppl):1505-10.
[DOI:10.1016/j.juro.2013.01.049] [PMID] [PMCID]
Nickavar A, Safaeian B, Biglari Abhari M. Radiologic
and clinical evaluation of children with first febrile urinary
tract infection. Int J Pediatr Adolesc Med. 2015; 2(1):24-8.
[DOI:10.1016/j.ijpam.2015.03.005] [PMID] [PMCID]
Zaki M, Badawi M, Al Mutari G, Ramadan D, Adul Rahman
M. Acute pyelonephritis and renal scarring in Kuwaiti
children: A follow-up study using 99mTc DMSA renal scintigraphy.
Pediatr Nephrol. 2005; 20(8):1116-9. [DOI:10.1007/
s00467-005-1880-2] [PMID]
Hitzel A, Liard A, Véra P, Manrique A, Ménard JF, Dacher
JN. Color and power Doppler sonography versus DMSA
scintigraphy in acute pyelonephritis and in prediction of renal
scarring. J Nucl Med. 2002; 43(1):27-32. [PMID]
Hitzel A, Liard A, Dacher JN, Gardin I, Ménard JF, Manrique
A, et al. Quantitative analysis of 99mTc-DMSA during
acute pyelonephritis for prediction of long-term renal scarring.
J Nucl Med. 2004; 45(2):285-9. [PMID]
Montini G, Zucchetta P, Tomasi L, Talenti E, Rigamonti
W, Picco G, et al. Value of imaging studies after a first febrile
urinary tract infection in young children: Data from Italian
renal infection study 1. Pediatrics. 2009; 123(2):e239-46.
[DOI:10.1542/peds.2008-1003] [PMID]
Temiz Y, Tarcan T, Onol FF, Alpay H, Simşek F. The efficacy
of Tc99m dimercaptosuccinic acid (Tc-DMSA) scintigraphy
and ultrasonography in detecting renal scars in children
with primary vesicoureteral reflux (VUR). Int Urol Nephrol.
; 38(1):149-52. [DOI:10.1007/s11255-005-3829-6] [PMID]
Koyle MA, Elder JS, Skoog SJ, Mattoo TK, Pohl HG, Reddy
PP, et al. Febrile urinary tract infection, vesicoureteral reflux,
and renal scarring: Current controversies in approach to
evaluation. Pediatr Surg Int. 2011; 27(4):337-46. [DOI:10.1007/
s00383-011-2863-y] [PMID]
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