Radio-Nuclear Investigations in Children Aged 16 Years and Younger with Confirmed Urinary Tract Infection: A Cross Sectional Retrospective Study
American Journal of Pediatrics
Volume 5, Issue 1, March 2019, Pages: 7-13
Received: Dec. 23, 2018;
Accepted: Jan. 29, 2019;
Published: Feb. 19, 2019
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Reem Al Qutami Al Suwaidi, College of Medicine, Mohammad Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates
Sam Hassan, Department of Pediatrics, Mediclinic City Hospital, Dubai, United Arab Emirates
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.
Reem Al Qutami Al Suwaidi,
Radio-Nuclear Investigations in Children Aged 16 Years and Younger with Confirmed Urinary Tract Infection: A Cross Sectional Retrospective Study, American Journal of Pediatrics.
Vol. 5, No. 1,
2019, pp. 7-13.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Alter SJ, Vidwan NK, Sobande PO, Omoloja A, Bennett JS. Common childhood bacterial infections. Current neurology and neuroscience reports. U. S. National Library of Medicine; 2011 Nov; 41 (10): 256-83.
Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gagyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. Ger Med Sci. 2016; 14 Doc0.
Uwaezuoke SN. Radiological Investigations of Urinary Tract Infection in. SM Group. 2015. (http: //smgebooks.com/urinary-tract infections/chapters/UTI-15-03.pdf).
Pokrajac D, Sefic-Pasic I, Begic A. Vesicoureteral Reflux and Renal Scarring in Infants After the First Febrile Urinary Tract Infection. Med Arch. 2018 Oct; 72 (4): 272-275.
Yılmaz İ, Peru H, Yılmaz FH, Sekmenli T, Çiftçi İ, Kara F Association of vesicoureteral reflux and renal scarring in urinary tract infections. Arch Argent Pediatr. 2018 Aug 1; 116 (4): e542-e547
Rennick, Janet E., et al. “Children’s Psychological Responses After Critical Illness and Exposure to Invasive Technology.” Journal of Developmental & Behavioral Pediatrics, vol. 23, no. 3, 2002, pp. 133–144.
Nasaif MN, Alghamdi AH, Ghamdi JA, Al-Dammas A. The results of different diagnostic imaging studies used in children with urinary tract infection. Sudanese Journal of Paediatrics. Sudan J Paediatr. 2015; 15 (1): 27–36.
Christian MT, McColl JH, MacKenzie JR, Beattie TJ. Risk assessment of renal cortical scarring with urinary tract infection byclinical features and ultrasonography. Arch Dis Child 2000; 82: 376–380.
Becknell B, Schober M, Korbel L, Spencer JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Rev Anti Infect Ther. 2015 Jan; 13 (1): 81–90.
Flores-Mireles AL, Jennifer NW, Michael C, Scott J. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May; 13 (5): 269–284.
Wei Tan C, Chlebicki MP. Urinary tract infections in adults. Singapore Med J. 2016 Sep; 57 (9): 485–490.
Supavekin S, Kucivilize K, Hunnangkul S, Sriprapaporn J, Pattaragarn A, Sumboonnanonda A. The relation of vesicoureteral reflux and renal scarring in childhood urinary tract infection. J Med Assoc Thai. 2006 Aug;89 Suppl 2: S41-7.
Gamss R, Stein MW, Rispoli JM, Cohen HW, Roberts JH, Koenigsberg M, Mazzariol FS, What is the Appropriate Use of Renal Ultrasound in an Inner City Population with New Onset Acute Kidney Injury? J Ultrasound Med. 2015 Sep; 34 (9): 1639–1644.
Biassoni L, Chippington S. Imaging in urinary tract infections: current strategies and new trends. Semin Nucl Med. 2008 Jan; 38 (1): 56-66.
Tewary K, Narchi H. Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics. World J Methodol. 2015 Jun 26; 5 (2): 13–19.
Vachvanichsanong P, Dissaneewate P, McNeil E. What Did We Find From Imaging Studies in Childhood Urinary Tract Infection and Which Studies Are Mandatory? Urology. 2018 Jan; 111: 176-182.
Zamir G, Sakran W, Horowitz Y, Koren A, Miron D. Urinary tract infection: is there a need for routine renal ultrasonography? Arch Dis Child. 2004 May; 89 (5): 466-8.
Platt C, Larcombe J, Dudley J, McNulty C, Banerjee J. Urinary tract infection Guidline in under 16s: diagnosis and management. Acta Paediat. 2015; Vol 104 (6):630-7. 2007. (https://www.nice.org.uk/guidance/cg54).