This study investigated whether performing kidney ultrasound (KUS) only in children presenting either a pathogen other than E. coli at their first febrile urinary tract infection (fUTI) or experiencing fUTI recurrence would increase missed diagnoses of kidney anomalies.
Patients aged 2–36 months with fUTI who underwent KUS evaluation from 2 January 2013 to 31 June 2018 were enrolled. Cystourethrography was performed after pathological KUS or recurring fUTIs. Thereafter, we retrospectively assessed the detection rate of kidney anomalies through performing KUS only in patients with atypical pathogen at first fUTI or with recurring fUTIs.
In 263 patients included, the isolated pathogen was E. coli in 223 cases (84.8%) and atypical in 40 cases (15.2%). KUS detected kidney anomalies in 14/223 (6.3%) of fUTIs caused by E. coli and in 11/40 (27.5%) of fUTIs caused by an atypical pathogen (OR 5.5, 95%CI 2.5–14.5). Cystourethrography was performed in 40 patients and vesicoureteral reflux (VUR) found in 20 cases. None of the high grade VUR diagnoses or other kidney anomalies would have been lost through a different diagnostic protocol that required the presence of an atypical pathogen at the first fUTI or a fUTI recurrence to perform the KUS.
A diagnostic protocol that requires presence of an atypical pathogen at the first fUTI or a second episode of fUTI to perform the KUS would allow a reduction in the number of negative ultrasounds with a negligible risk of missed diagnoses of kidney anomalies.
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Congenital anomalies of the kidney and urinary tract
Febrile urinary tract infection
Italian Society of Paediatric Nephrology
Ammenti A, Alberici I, Brugnara M, Chimenz R, Guarino S, La Manna A, La Scola C, Maringhini S, Marra G, Materassi M, Morello W, Nicolini G, Pennesi M, Pisanello L, Pugliese F, Scozzola F, Sica F, Toffolo A, Montini G (2020) Updated Italian recommendations for the diagnosis, treatment and follow-up of the first febrile urinary tract infection in young children. Acta Paediatr 109:236–247
Subcommittee on urinary tract infection (2016) Reaffirmation of AAP Clinical Practice Guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age. Pediatrics 138:e20163026
Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Tekgül S, European Association of Urology; European Society for Pediatric Urology (2015) Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol 67:546–558
Robinson JL, Finlay JC, Lang ME, Bortolussi R, Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Community Paediatrics Committee (2014) Urinary tract infections in infants and children: diagnosis and management. Paediatr Child Health 19:315–325
NICE: National Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and long term management. Available at: www.nice.org.uk/nicemedia/pdf/CG54fullguideline.pdf. Accessed October 15, 2020
McTaggart S, Danchin M, Ditchfield M, Hewitt I, Kausman J, Kennedy S, Trnka P, Williams G, Kidney Health Australia - Caring for Australasians with Renal Impairment (2015) KHA-CARI guideline: diagnosis and treatment of urinary tract infection in children. Nephrology (Carlton) 20:55–60
Abdelhalim A, Khoury AE (2017) Critical appraisal of the top-down approach for vesicoureteral reflux. Investig Clin Urol 58:S14–S22
Pauchard JY, Chehade H, Kies CZ, Girardin E, Cachat F, Gehri M (2017) Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound. Arch Dis Child 102:804–808
La Scola C, De Mutiis C, Hewitt IK, Puccio G, Toffolo A, Zucchetta P, Mencarelli F, Marsciani M, Dall'Amico R, Montini G (2013) Different guidelines for imaging after first UTI in febrile infants: yield, cost, and radiation. Pediatrics 131:e665–e671
Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, Materassi M, Pecile P, Pennesi M, Pisanello L, Sica F, Toffolo A, Montini G, Italian Society of Pediatric Nephrology (2012) Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr 101:451–457
Alberici I, La Manna A, Pennesi M, Starc M, Scozzola F, Nicolini G, Toffolo A, Marra G, Chimenz R, Sica F, Maringhini S, Monasta L, Montini G (2019) First urinary tract infections in children: the role of the risk factors proposed by the Italian recommendations. Acta Paediatr 108:544–550
Hewitt IK, Montini G (2017) Re-evaluating the use of ultrasound to investigate first febrile urinary tract infections in childhood. Acta Paediatr 106:1727–1728
http://dati.istat.it/ Accessed on 1 May 2020
Shaikh N, Morone NE, Bost JE, Farrell MH (2008) Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 27:302–308
Venhola M, Uhari M (2009) Vesicoureteral reflux, a benign condition. Pediatr Nephrol 24:223–226
Hodson J, Maling TM, McManamon PJ, Lewis MG (1975) Reflux nephropathy. Kidney Int Suppl 4:S50–S58
Hewitt I, Montini G (2020) Vesicoureteral reflux is it important to find? Pediatr Nephrol. https://doi.org/10.1007/s00467-020-04573-9
Harambat J, van Stralen KJ, Kim JJ, Tizard EJ (2012) Epidemiology of chronic kidney disease in children. Pediatr Nephrol 27:363–373
Craig JC, Irwig LM, Knight JF, Roy LP (2000) Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 105:1236–1241
Brakeman P (2008) Vesicoureteral reflux, reflux nephropathy, and end-stage renal disease. Adv Urol 2008:508949
Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L (2006) Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 117:626–632
Brandström P, Esbjörner E, Herthelius M, Holmdahl G, Läckgren G, Nevéus T, Sillén U, Sixt R, Sjöberg I, Stokland E, Jodal U, Hansson S (2010) The Swedish reflux trial in children: I. Study design and study population characteristics. J Urol 184:274–279
Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A, North East Italy Prophylaxis in VUR study group (2008) Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics 121:e1489–e1494
Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, Cecchin D, Pavanello L, Molinari PP, Maschio F, Zanchetta S, Cassar W, Casadio L, Crivellaro C, Fortunati P, Corsini A, Calderan A, Comacchio S, Tommasi L, Hewitt IK, Da Dalt L, Zacchello G, Dall'Amico R, IRIS Group (2008) Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 122:1064–1071
Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, Raymond F, Grellier A, Hazart I, de Parscau L, Salomon R, Champion G, Leroy V, Guigonis V, Siret D, Palcoux JB, Taque S, Lemoigne A, Nguyen JM, Guyot C (2008) Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol 179:674–679
Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, SJ MT, Hodson EM, Carapetis JR, Cranswick NE, Smith G, Irwig LM, Caldwell PH, Hamilton S, Roy LP, Prevention of Recurrent Urinary Tract Infection in Children with Vesicoureteric Reflux and Normal Renal Tracts (PRIVENT) Investigators (2009) Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med 361:1748–1759
Trial Investigators RIVUR, Hoberman A, Greenfield SP, Mattoo TK, Keren R, Mathews R, Pohl HG, Kropp BP, Skoog SJ, Nelson CP, Moxey-Mims M, Chesney RW, Carpenter MA (2014) Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med 370:2367–2376
Hewitt IK, Pennesi M, Morello W, Ronfani L, Montini G (2017) Antibiotic prophylaxis for urinary tract infection-related renal scarring: a systematic review. Pediatrics 139:e20163145
Pennesi M, L'erario I, Travan L, Ventura A (2012) Managing children under 36 months of age with febrile urinary tract infection: a new approach. Pediatr Nephrol 27:611–615
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Pennesi, M., Amoroso, S., Pennesi, G. et al. Is ultrasonography mandatory in all children at their first febrile urinary tract infection?. Pediatr Nephrol (2021). https://doi.org/10.1007/s00467-020-04909-5
- Febrile urinary tract infections
- Kidney ultrasound