The first goal of imaging the urinary tract is to discover abnormalities that either may be risk factors for UTI or may preclude prompt response to therapy. These risk factors include vesicoureteral reflux or voiding dysfunction, and factors that complicate therapy include partial ureteropelvic junction obstruction or cystic kidney disease. The second goal of imaging is to monitor renal growth and detect scarring.Determining which children to evaluate, which tests are most appropriate, and when to obtain studies is critical to develop a rational and consistent approach to this controversial component of UTI.
For a long time, majority opinion favored imaging evaluation of the upper and lower urinary tract in every child following a well-documented first UTI.
(1) All patients with documented UTI should have ultrasound to assess integrity of the urinary tract;
(2) VCUG should be obtained in all patients less than 3 years of age and all patients with or suspected of having pyelonephritis;
(3) No further studies if ultrasound is normal in children older than 3 years or with minimal symptoms at presentation.
There are several reasons for routinely imaging infants and young children with UTI:
(1) a high incidence of VUR is found in this age group, approaching 35 to 50% (70% in children <1 year);
(2) renal scarring following infection is most likely to occur in the first 2 to 4 years of life; and
(3) symptoms are so vague that differentiation between upper and lower tract infection is usually Continue reading »
