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Evaluating different imaging strategies in children after first febrile urinary tract infection

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Abstract

We conducted a retrospective multicenter review to estimate the prevalence of urological abnormalities in Chinese children with first febrile urinary tract infection (UTI) and to evaluate the selective imaging strategy recommended by the NICE guideline for detecting underlying abnormalities. Atypical UTI was defined as in the NICE UTI guideline. Overall, 576 boys and 244 girls aged below 24 months were reviewed. All underwent ultrasound (US) and micturating cystourethrogram (MCUG) and 612 underwent DMSA scans. US was abnormal in 73 (8.9%) and vesicoureteral reflux was shown in 195 patients (23.8%). A total of 126 patients were considered to have remediable urological abnormalities requiring additional surgical or medical interventions. The NICE guideline yielded excellent negative predictive values (NPV) of 100–94.4% in girls but 91% in boys. If all boys underwent US and DMSA and only those with atypical UTI or abnormal US or DMSA proceeded to MCUG, then the NPV increased to 95.2% and 97.4% for boys aged below and above 6 months, respectively. These revised strategies would substantially save invasive studies—DMSA and MCUG in 27 and 74% of girls aged below and above 6 months, respectively, or MCUG in 23 and 59% of boys aged below and above 6 months, respectively.

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References

  1. Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U (1991) Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child 66:232–234

    Article  PubMed  Google Scholar 

  2. Working Group of the Research Unit, Royal College of Physicians (1991) Guidelines for the management of acute urinary tract infection in childhood. Report of a Working Group of the Research Unit, Royal College of Physicians. J R Coll Physicians London 25:36–42

  3. Jodal U, Lindberg U (1999) Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Acta Paediatr 88:87–89

    CAS  Google Scholar 

  4. American Academy of Pediatrics Committee on Quality Improvement Subcommittee on Urinary Tract Infection (1999) Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. Pediatrics 103:843–852

    Google Scholar 

  5. Risdon RA, Yeung CK, Ransley PG (1993) Reflux nephropathy in children submitted to unilateral nephrectomy: a clinicopathological study. Clin Nephrol 40:308–314

    CAS  PubMed  Google Scholar 

  6. Risdon RA (1993) The small scarred kidney in childhood. Pediatr Nephrol 7:361–364

    Article  CAS  PubMed  Google Scholar 

  7. Stock JA, Wilson D, Hanna MK (1998) Congenital reflux nephropathy and severe unilateral fetal reflux. J Urol 160:1017–1018

    Article  CAS  PubMed  Google Scholar 

  8. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202

    Article  PubMed  Google Scholar 

  9. Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS (2003) Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol 14:739–744

    Article  PubMed  Google Scholar 

  10. Garin EH, Olavarria F, Nieto VG, 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  CAS  PubMed  Google Scholar 

  12. Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A, for the 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

    Article  Google Scholar 

  13. National Collaborating Centre for Women's and Children's Health (2007) Urinary tract infection in children. Diagnosis, treatment and long-term management. RCOG Press, London, Web site: http://guidance.nice.org.uk/CG54, last accessed 22nd March 2010

  14. Mori R, Lakhanpaul M, Verrier-Jones K (2007) Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ 335:395–397

    Article  PubMed  Google Scholar 

  15. Wong SN, Chiu W, Ho S, Ko PW, Lam W, Yeung CK, Chiu MC, Ho CS, Wong W (2002) Clinical guideline on management of urinary tract infections in children below 2 years of age (part I): the diagnosis and initial management. H K J Paediatr (new series) 7:205–213

    Google Scholar 

  16. Wong SN, Chiu W, Ho S, Ko PW, Lam W, Yeung CK, Chiu MC, Ho CS, Wong W (2003) Clinical guideline on management of urinary tract infections in children below 2 years of age (part II): investigations following a documented infection. H K J Paediatr (new series) 8:47–54

    Google Scholar 

  17. National Collaborating Centre for Women's and Children's Health. Feverish illness in children. Assessment and initial management in children younger than 5 years. 1–142. 2007. RCOG Press, London. Web site: http://guidance.nice.org.uk/CG47, last accessed 22nd March 2010

  18. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE (1985) International system of grading vesicoureteral reflux. Pediatr Radiol 15:399–405

    Article  PubMed  Google Scholar 

  19. Zamir G, Sakran W, Horowitz Y, Koren A, Miron D (2004) Urinary tract infection: is there a need for routine renal ultrasonography? Arch Dis Child 89:466–468

    Article  CAS  PubMed  Google Scholar 

  20. Giorgi LJ Jr, Bratslavsky G, Kogan BA (2005) Febrile urinary tract infections in infants: renal ultrasound remains necessary. J Urol 173:568–570

    Article  PubMed  Google Scholar 

  21. Downs SM (1999) American Academy of Pediatrics technical report: urinary tract infections in febrile infants and young children. Pediatrics 103:e54–1–e54–60

    Article  Google Scholar 

  22. Hoberman A, Keren R (2009) Antimicrobial prophylaxis for urinary tract infection in children. N Engl J Med 361:1804–1806

    Article  CAS  PubMed  Google Scholar 

  23. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, Hodson EM, Carapetis JR, Cranswick NE, Smith G, Irwig LM, Caldwell PHY, Hamilton S, Roy LP; The 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

    Article  CAS  PubMed  Google Scholar 

  24. Montini G, Hewitt I (2009) Urinary tract infections: to prophylaxis or not to prophylaxis? Pediatr Nephrol 24:1605–1609

    Article  PubMed  Google Scholar 

  25. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, Maschio G, Brenner BM, Kamper A, Zucchelli P, Becker G, Himmelmann A, Bannister K, Landais P, Shahinfar S, de Jong PE, de Zeeuw D, Lau J, Levey AS (2001) Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med 135:73–87

    CAS  Google Scholar 

  26. Wuhl E, Mehls O, Schaefer F, and the ESCAPE Trial Group (2004) Antihypertensive and antiproteinuric efficacy of ramipril in children with chronic renal failure. Kidney Int 66:768–776

    Article  Google Scholar 

  27. Tse NKC, Yuen SLK, Chiu MC, Lai WM, Tong PC (2009) Imaging studies for first urinary tract infection in infants less than 6 months old: can they be more selective? Pediatr Nephrol 24:1699–1703

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatrics & Adolescent Medicine, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, Hong Kong

    Sik-Nin Wong

  2. Department of Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Princess Margaret Hospital Road, Kowloon, Hong Kong

    Niko Kei-Chiu Tse

  3. Department of Paediatrics & Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital, Chuen On Road, Tai Po, Hong Kong

    Kwok-Piu Lee

  4. Department of Paediatrics & Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Lok Man Road, Chai Wan, Hong Kong

    So-Fun Yuen

  5. Department of Paediatrics, Kwong Wah Hospital, Waterloo Road, Kowloon, Hong Kong

    Lettie Chuk-Kwan Leung & Benjamin Chee-Kit Pau

  6. Department of Paediatrics, Queen Elizabeth Hospital, Gascoigne Road, Kowloon, Hong Kong

    Winnie Kwai-Yu Chan & Kwok-Wai Lee

  7. Department of Paediatrics, Prince of Wales Hospital, Ngan Shing Street, Shatin, Hong Kong

    Hon-Ming Cheung

  8. Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong

    Stella Chim

  9. Department of Paediatrics & Adolescent Medicine, United Christian Hospital, Hip Wo Street, Kwun Tong, Hong Kong

    Cynthia Mung-Sze Yip

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  1. Sik-Nin Wong
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  2. Niko Kei-Chiu Tse
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  3. Kwok-Piu Lee
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  5. Lettie Chuk-Kwan Leung
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  9. Hon-Ming Cheung
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  11. Cynthia Mung-Sze Yip
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Correspondence to Sik-Nin Wong.

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Wong, SN., Tse, N.KC., Lee, KP. et al. Evaluating different imaging strategies in children after first febrile urinary tract infection. Pediatr Nephrol 25, 2083–2091 (2010). https://doi.org/10.1007/s00467-010-1569-z

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  • DOI: https://doi.org/10.1007/s00467-010-1569-z

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