Children urinary infection

Imaging assessment

  • Mercedes Bernadá Universidad de la República, Facultad de Medicina, Pediatría, Prof. Adj.
  • Macarena Pereda Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente. Pediatra
  • Ana Fernández Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente
  • Flor Russomano Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente
  • Bernardo Alonso Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente. Pediatra
  • Luciano Álvarez Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente. Pediatra
  • Claudio Varacchi Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente. Pediatra
  • Rosana Lechini Hospital de Salto, Pediatra
  • Silvana Mariño Clínica Pediátrica B, Pediatra
  • Mercedes Traversa Hospital de Flores, Pediatra
  • Andrea Otero Hospital Central de las Fuerzas Armadas, Ex Residente. Pediatra
  • Sisina Patiño Hospital Central de las Fuerzas Armadas, Ex Residente. Pediatra
  • Virginia Perdomo Centro Hospitalario Pereira Rossell, Clínica Pediátrica B, Ex Residente. Pediatra
Keywords: URINARY INFECTIONS, SKYLONPHRITIS, UROGRAPHY, CINTIGRAPHY, CHILD

Abstract

Urinary tract infection (UTI) is frequently seen in pediatry and it is considered as a biological marker of anatomic and functional disease of the urinary system in children.
A prospective study took place in four Uruguayan state hospitals at the aim of: to know the prevalence of the associated nephrourinary disease, to compare the voiding cystourethrography (VC) results of two collections, to analize in infants younger than 2 years, scintigraphy findings related to ‘suggestive parameters of acute pyelonephritis’ (AP), and to determine centellographic progression of the disease.
All infants carriers of urinary tract infection underwent renal and urinary ecography. Voiding cystouretrogra-phy was performed in infants under five years and some selected children older than this age, in two periods: one month after the urinary tract infection and during the treatment.
Acute renal scintigraphy was performed in infants under 2 years and some selected children. The study included 168 children. Results were as follow: 21% of echographies showed alterations; 30% of VC were pathological (26% of the male population and 32% of female population). In the second period, studies increased significantly but no differences related to the quantity and severity of vesico-uretral reflux were seen (total: 26%). Half of the scintigraphy results were pathological, especially AP images. Under two year-old infants with at least two ‘suggestive parameters of AP’ showed normal scintigraphy in half of the cases.
Anatomic and functional assessment of the urinary system to all children since their first UTI is highlighted.

References

1) Hansson S, Jodal U. Urinary Tract Infection. In: Barret MT, Avner ED, Harmon WE, eds. Pediatric Nephrology. 4 ed. Baltimore: Lippincott, Williams&Wilkins, 1998: 835-50.
2) Craig JC. Urinary tract infection: a new perspectives on a common disease. Curr Opin Infect Dis 2001; 14(3): 309-13.
3) Mahaut S, To T, Friedman J. Timing of voiding cystourethrogram in the investigation of urinary tract infections in children. J Pediatr 2001; 139(4): 568-71.
4) Smellie JM, Rigden SP, Prescod NP. Urinary tract infection: a comparison of four methods of investigation. Arch Dis Child 1995; 72(3): 247-50.
5) Dick PT, Feldman W. Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr 1996; 128(1): 15-22.
6) Hellerstein S. Urinary tract infections: old and new concepts. Pediatr Clin North Am 1995; 42(6): 1433-57.
7) Rushton HG. Vesicoureteral reflux and scarring. In: Barret MT, Avner ED, Harmon WE, eds. Pediatric Nephrology. 4 ed. Baltimore: Lippincott, Williams&Wilkins, 1998: 851-66.
8) American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999; 103(4 Pt 1): 843-51.
9) Jodal U, Lindberg U. Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Swedish Medical Research Council. Acta Paediatr Suppl 1999; 88(431): 87-9.
10) Craig JC, Irwing LM, Knight JF, Roy LP. Does treatment of vesicoureteric reflux in chilhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 2000; 105(6): 1236-41. [Pediatrics (ed. Esp.) 2000; 49(6): 373-8.]
11) Le-Saux N, Pham B, Moher D. Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review. CMAJ 2000; 163(5):523-9.
12) Wennerstrom M, Hansson S, Jodal U, Sixt R, Stokland E. Renal function 16 to 26 years after the first urinary tract infection in childhood. Arch Pediatr Adolesc Med 2000; 154(4): 339-45.
13) Cho SJ, Lee SJ. ACE gene polymorphism and renal scar in children with acute pyelonephritis. Pediatr Nephrol 2002; 17(7): 491-5.
14) Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348(3): 195-202.
15) Alonso B, Bernadá M, Pereda M, Traversa M, Lechini R, Mariño S, et al. Infección urinaria en niños: agentes patógenos y sensibilidad antibiótica. Arch Pediatr Urug 2001; 72(4): 270-5.
16) Universidad de la República. Facultad de Medicina. Clínicas Pediátricas "A", "B", "C". Departamento de Emergencia Pediátrica. Infección Urinaria. In: Atención Pediátrica: pautas de diagnóstico, tratamiento y pronóstico. 4 ed. Montevideo: Oficina del Libro AEM, 1995: 129-34.
17) Rushton HG, Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol 1992; 148(5 Pt 2): 1726-32.
18) Stokland E, Hellstrom M, Jacobsson B, Jodal U, Lundgren P, Sixt R. Early 99mTc dimercaptosuccinic acid (DMSA) scintigraphy in symptomatic first-time urinary tract infection. Acta Paediatr 1996; 85(4): 430-6.
19) Berhman R, Kliegman R, Nelson W, Vaughan III V. Nelson Tratado de Pediatría. 14° ed. Madrid: Mc Graw-Hill Interamericana, 1992: 1492.
20) Downs SM. Technical report: urinary tract infections in febrile infants and young children. Pediatrics 1999; 103(4): e54.
21) Koch VH, Zuccolotto SM. Urinary tract infection: a search for evidence. J Pediatr (Rio J) 2003; 79 (Suppl 1): S97-106.
22) Rushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol 1997; 11(1): 108-20.
23) Stokland E, Hellstrom M, Jacobsson B, Sixt R. Imaging of renal scarring. Acta Paediatr Suppl 1999; 88(431): 13-21.
24) Craig JC, Knight JF, Sureshkumar P, Lam A, Onikul E, Roy LP. Vesicoureteric reflux and timing of micturating cystourethrography after urinary tract infection. Arch Dis Child 1997; 76(3): 275-7.
25) McDonald A, Scranton M, Gillespie R, Mahajan V, Edwars GA. Voiding cystourethrograms and urinary tract infections: how long to wait? Pediatrics 2000; 105(4): e50.
26) Goldraich NP, Goldraich IH. Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection. Pediatr Nephrol 1995; 9(2): 221-6; discussion 227.
27) Benador D, Benador N, Slosman DO, Nussle D, Mermillod B, Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr 1994; 124(1): 17-20.
28) Martín-Aguado MJ, Canals-Baeza A, Vioque-López J, Tarazona JL, Flores-Serrano J. Gammagrafía con tecnecio-99m-ácido dimercaptosuccínico en el estudio de la primera infección urinaria febril del niño. An Esp Pediatr 2000; 52(1): 23-30.
29) Castelló-Girona F, Vilaplana-Canto E, Yeste-Fernández D, Roca-Bielsa I, Enríquez-Cívico G. Gammagrafía con 99m-tecnesio-ácido dimercaptosuccínico en el estudio de la primera infección urinaria del lactante. An Esp Pediatr 1995; 42(2): 118-22.
30) Biggi A, Dardanelli L, Pomero G, Cussino P, Noello Ch, Sernia O, et al. Acute renal cortical scintigraphy in children with a first urinary tract infection. Pediatr Nephrol 2001; 16(9): 733-8.
31) Stokland E, Hellstrom M, Jacobsson B, Jodal U, Sixt R. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr 1996; 129(6): 815-20.
32) Matesanz-Pérez JL, Fernández-Menéndez JM, Gracia-Chapulle A, Aira-Delgado F, Rodríguez-Posada R, Ballesteros-García S. Utilidad de la gammagrafía con ácido dimercaptosuccínico (DMSA) marcado con Tc99 en el protocolo de estudio de la infección urinaria en un hospital de segundo nivel. An Esp Pediatr 1998; 48(1): 21-4.
33) Smellie JM. Technetium-99m-dimercaptosuccinic acid studies and urinary tract infection in childhood. Acta Paediatr 1998; 87(2): 132-3.
Published
2005-10-31
How to Cite
1.
Bernadá M, Pereda M, Fernández A, Russomano F, Alonso B, Álvarez L, Varacchi C, Lechini R, Mariño S, Traversa M, Otero A, Patiño S, Perdomo V. Children urinary infection. Rev. Méd. Urug. [Internet]. 2005Oct.31 [cited 2024Nov.17];21(3):222-30. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/807
Issue
Vol 21 No 3 (2005): Revista Médica del Uruguay
Section
Original Articles
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