FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 348:195-202 January 16, 2003 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Stapleton, F. B. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary tract infection; renal scanning with technetium-99m–labeled dimercaptosuccinic acid has also been endorsed by other authorities. We investigated whether imaging studies altered management or improved outcomes in young children with a first febrile urinary tract infection.

Methods In a prospective trial involving 309 children (1 to 24 months old), an ultrasonogram and an initial renal scan were obtained within 72 hours after diagnosis, contrast voiding cystourethrography was performed one month later, and renal scanning was repeated six months later.

Results The ultrasonographic results were normal in 88 percent of the children (272 of 309); the identified abnormalities did not modify management. Acute pyelonephritis was diagnosed in 61 percent of the children (190 of 309). Thirty-nine percent of the children who underwent cystourethrography (117 of 302) had vesicoureteral reflux; 96 percent of these children (112 of 117) had grade I, II, or III vesicoureteral reflux. Repeated scans were obtained for 89 percent of the children (275 of 309); renal scarring was noted in 9.5 percent of these children (26 of 275).

Conclusions An ultrasonogram performed at the time of acute illness is of limited value. A voiding cystourethrogram for the identification of reflux is useful only if antimicrobial prophylaxis is effective in reducing reinfections and renal scarring. Renal scans obtained at presentation identify children with acute pyelonephritis, and scans obtained six months later identify those with renal scarring. The routine performance of urinalysis, urine culture, or both during subsequent febrile illnesses in all children with a previous febrile urinary tract infection will probably obviate the need to obtain either early or late scans.

Source Information

From the Departments of Pediatrics (A.H., R.W.H., E.R.W.) and Radiology (M.C.), University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, Pittsburgh; the Department of Pediatrics, Ohio State University and Columbus Children's Hospital, Columbus (R.W.H.); the Department of Pediatrics, Harvard Medical School and Children's Hospital, Boston (M.B.); and the Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh (D.H.K.).

Address reprint requests to Dr. Hoberman at Children's Hospital of Pittsburgh, 3705 5th Ave., Pittsburgh, PA 15213-2583, or at hoberman{at}chp.edu.

Full Text of this Article

Related Letters:

Imaging Studies after a First Febrile Urinary Tract Infection in Young Children
Nishisaki A., Gordon I., Kallen R., Hoberman A., Hickey R. W., Wald E. R.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1812-1814, May 1, 2003. Correspondence

This article has been cited by other articles:

• Siomou, E., Giapros, V., Fotopoulos, A., Aasioti, M., Papadopoulou, F., Serbis, A., Siamopoulou, A., Andronikou, S. (2009). Implications of 99mTc-DMSA Scintigraphy Performed During Urinary Tract Infection in Neonates. Pediatrics 124: 881-887 [Abstract] [Full Text]  
• Pecile, P., Miorin, E., Romanello, C., Vidal, E., Contardo, M., Valent, F., Tenore, A. (2009). Age-Related Renal Parenchymal Lesions in Children With First Febrile Urinary Tract Infections. Pediatrics 124: 23-29 [Abstract] [Full Text]  
• Montini, G., Zucchetta, P., Tomasi, L., Talenti, E., Rigamonti, W., Picco, G., Ballan, A., Zucchini, A., Serra, L., Canella, V., Gheno, M., Venturoli, A., Ranieri, M., Caddia, V., Carasi, C., Dall'Amico, R., Hewitt, I. (2009). Value of Imaging Studies After a First Febrile Urinary Tract Infection in Young Children: Data From Italian Renal Infection Study 1. Pediatrics 123: e239-e246 [Abstract] [Full Text]  
• Koljalg, S., Truusalu, K., Vainumae, I., Stsepetova, J., Sepp, E., Mikelsaar, M. (2009). Persistence of Escherichia coli Clones and Phenotypic and Genotypic Antibiotic Resistance in Recurrent Urinary Tract Infections in Childhood. J. Clin. Microbiol. 47: 99-105 [Abstract] [Full Text]  
• Keren, R. (2008). Introduction. Pediatrics 122: S231-S232 [Full Text]  
• Geier, P., Strojil, J., Kutrova, K. (2008). Therapeutic Delay in Infant Urinary Tract Infection: Does It Really Have No Impact?. Pediatrics 122: 215-216 [Full Text]  
• 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, (2008). Is Antibiotic Prophylaxis in Children With Vesicoureteral Reflux Effective in Preventing Pyelonephritis and Renal Scars? A Randomized, Controlled Trial. Pediatrics 121: e1489-e1494 [Abstract] [Full Text]  
• Williams, G., Fletcher, J. T., Alexander, S. I., Craig, J. C. (2008). Vesicoureteral Reflux. J. Am. Soc. Nephrol. 19: 847-862 [Abstract] [Full Text]  
• Buckley, O, Geoghegan, T, O'Brien, J, Torreggiani, W C (2007). Vesicoureteric reflux in the adult. Br. J. Radiol. 80: 392-400 [Abstract] [Full Text]  
• Miron, D., Daas, A., Sakran, W., Lumelsky, D., Koren, A., Horovitz, Y. (2007). Is omitting post urinary-tract-infection renal ultrasound safe after normal antenatal ultrasound? An observational study. Arch. Dis. Child. 92: 502-504 [Abstract] [Full Text]  
• Bundy, D. G., Serwint, J. R. (2007). Vesicoureteral Reflux. Pediatr. Rev. 28: e6-e8 [Full Text]  
• Oreskovic, N. M., Sembrano, E. U. (2007). Repeat Urine Cultures in Children Who Are Admitted With Urinary Tract Infections. Pediatrics 119: e325-e329 [Abstract] [Full Text]  
• Conway, P. H., Edwards, S., Stucky, E. R., Chiang, V. W., Ottolini, M. C., Landrigan, C. P. (2006). Variations in Management of Common Inpatient Pediatric Illnesses: Hospitalists and Community Pediatricians. Pediatrics 118: 441-447 [Abstract] [Full Text]  
• Galanakis, E., Bitsori, M., Dimitriou, H., Giannakopoulou, C., Karkavitsas, N. S., Kalmanti, M. (2006). Urine Interleukin-8 as a Marker of Vesicoureteral Reflux in Infants. Pediatrics 117: e863-e867 [Abstract] [Full Text]  
• Friedman, A. L. (2006). Rethinking UTI Prophylaxis. AAP Grand Rounds 15: 26-27 [Full Text]  
• Wald, E. R. (2006). Vesicoureteral Reflux: The Role of Antibiotic Prophylaxis. Pediatrics 117: 919-922 [Full Text]  
• Leroy, S, Marc, E, Adamsbaum, C, Gendrel, D, Breart, G, Chalumeau, M (2006). Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule. Arch. Dis. Child. 91: 241-244 [Abstract] [Full Text]  
• Blumenthal, I (2006). Vesicoureteric reflux and urinary tract infection in children. Postgrad. Med. J. 82: 31-35 [Abstract] [Full Text]  
• Hellerstein, S. (2005). Renal Imaging Studies After First UTI in Infants: Cystography Has Limited Utility. AAP Grand Rounds 14: 61-62 [Full Text]  
• Newman, T. B. (2005). Evidence Does Not Support American Academy of Pediatrics Recommendation for Routine Imaging After a First Urinary Tract Infection. Pediatrics 116: 1613-1614 [Full Text]  
• Raszka, W. V. Jr, Khan, O. (2005). Pyelonephritis. Pediatr. Rev. 26: 364-370 [Full Text]  
• Jodorkovsky, R. (2005). Compliance With Guidelines for the Medical Care of First Urinary Tract Infections in Infants. Pediatrics 116: 1051-1052 [Full Text]  
• Moorthy, I, Easty, M, McHugh, K, Ridout, D, Biassoni, L, Gordon, I (2005). The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch. Dis. Child. 90: 733-736 [Abstract] [Full Text]  
• Cohen, A. L., Rivara, F. P., Davis, R., Christakis, D. A. (2005). Compliance With Guidelines for the Medical Care of First Urinary Tract Infections in Infants: A Population-Based Study. Pediatrics 115: 1474-1478 [Abstract] [Full Text]  
• Leroy, S., Adamsbaum, C., Marc, E., Moulin, F., Raymond, J., Gendrel, D., Breart, G., Chalumeau, M. (2005). Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection. Pediatrics 115: e706-e709 [Abstract] [Full Text]  
• Zorc, J. J., Kiddoo, D. A., Shaw, K. N. (2005). Diagnosis and Management of Pediatric Urinary Tract Infections. Clin. Microbiol. Rev. 18: 417-422 [Abstract] [Full Text]  
• Bradshaw, K (2004). Urinary tract infections. Imaging 16: 124-129 [Abstract] [Full Text]  
• Beattie, T J (2004). Imaging guidelines for urinary tract infection in childhood; time for change?. Arch. Dis. Child. 89: 398-399 [Full Text]  
• 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 [Abstract] [Full Text]  
• Schulman, S. L. (2003). Guidelines can help manage urinary tract infections. AAP News 23: 284-285 [Full Text]  
• (2003). Selections from Journal Watch Pediatrics and Adolescent Medicine. Arch. Dis. Child. 88: 740-741 [Full Text]  
• Wyatt, J P, Freeman, L (2003). JournalScan. Emerg. Med. J. 20: 373-374 [Full Text]  
• (2003). Imaging after urinary tract infection reconsidered. Arch. Dis. Child. 88: 522-522 [Full Text]  
• Nishisaki, A., Gordon, I., Kallen, R., Hoberman, A., Hickey, R. W., Wald, E. R. (2003). Imaging Studies after a First Febrile Urinary Tract Infection in Young Children. NEJM 348: 1812-1814 [Full Text]  
• Friedman, A. L., Wood, B. P., Rathore, M. H. (2003). What Imaging Studies, If Any, Are Needed After a First Febrile Urinary Tract Infection in Young Children?. AAP Grand Rounds 9: 37-38 [Full Text]  
• (2003). UTIs: What's the Best Imaging Study?. JWatch Pediatrics 2003: 2-2 [Full Text]  
• (2003). Which Imaging Studies for Children with First Urinary Tract Infection?. JWatch Infect. Diseases 2003: 3-3 [Full Text]  
• Stapleton, F. B. (2003). Imaging Studies for Childhood Urinary Infections. NEJM 348: 251-252 [Full Text]