ORIGINAL ARTICLE

Is omitting post urinary-tract-infection renal ultrasound safe after normal antenatal ultrasound? An observational study

Dan Miron¹, Ahmed Daas¹, Waheeb Sakran², Dimitry Lumelsky³, Ariel Koren², Yoseph Horovitz¹

¹ Pediatric Department A, HaEmek Medical Center, Afula, Israel
² Pediatric Department B, HaEmek Medical Center, Afula, Israel
³ Radiology Department, HaEmek Medical Center, Afula, Israel

Correspondence to:
Dr Dan Miron
Pediatric Department A, HaEmek Medical Center, Afula 18101, Israel;miron_da{at}clalit.org.il

Background: Guidelines recommend obtaining a renal ultrasonogram (RUS) for young children after a first urinary tract infection (UTI).

Objective: The aim of the current study was to assess the concordance of prenatal and post-UTI RUS findings in children with a first simple UTI.

Methods: This was a prospective study and included all children aged 5 years or younger who were hospitalised with a first simple UTI (determined as clinical response and normalisation of temperature within 48 h on initiation of antibacterial therapy with no complications). Data were collected from each child regarding the results of prenatal and post-UTI RUS.

Results: Overall, 250 children were included in the study and the results of late-pregnancy and post-UTI RUS were available for 84% (n = 209). Complete concordance between the two RUS was demonstrated in 96% (n = 201). The predictive value of normal antenatal to normal post-UTI RUS was 96% (95% CI: 93% to 99%). These results include four children with mild transient pelvic dilatation. In eight children in whom renal anomalies were demonstrated only in post-UTI RUS, the influence of these anomalies on the children’s management was negligible.

Conclusions: Prenatal-RUS have been performed in most children <5 years old hospitalised with a first simple UTI. Concordance with post-infection tests is very high. Findings which appear only in post-infectious RUS usually have negligible effects on children’s management. Thus, in such children with normal antenatal RUS omitting post-UTI RUS could be considered.

Abbreviations: RUS, renal ultrasonogram; UTI, urinary tract infection; VCUG, voiding cystourethrography; VUR, vesicourethral reflux

Keywords: renal ultrasonogram; urinary tract infection; child; pregnancy; vesicourethral reflux

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• Lim, R. (2009). Vesicoureteral Reflux and Urinary Tract Infection: Evolving Practices and Current Controversies in Pediatric Imaging. Am. J. Roentgenol. 192: 1197-1208 [Abstract] [Full Text]  
• (2007). Is Renal Ultrasound After First UTI Necessary?. JWatch Pediatrics 2007: 1-1 [Full Text]