Role of imaging in children with urinary tract infections

Background: As per recommendation from the American Academy of pediatrics a child with first episode of urinary tract infection should be evaluated for underlying urinary tract abnormalities by undergoing voiding cystourethrogram, ultrasonogram of urinary tract and radionuclide imaging of kidney. We studied role of these imaging studies in picking up renal abnormalities. Methods:  We conducted a descriptive study in which 100 children aged 1mth-12 years with documented urinary tract infection (UTI) were included. Ultrasonogram (USG) and radionuclide renal scan were obtained at the time of admission. Voiding cystourethrography (VCUG) was performed after 6weeks to look for vesicoureteric reflux. Results: Forty three children underwent both DMSA and follow up VCUG. Ultrasonogram picked up acute pyelonephritis (APN) in 7.1% of children with UTI while 31.1% had pyelonephritis on DMSA. Overall incidence of VUR was 16.3%. The sensitivity of USG for VUR detection was only 14.2%. The sensitivity of USG as a screening test for APN is 7%. Conclusions:  All children less than five years with UTI must undergo DMSA and VCUG. Ultrasonography is less sensitive in detecting VUR and acute pyelonephritis.