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Re: Guidelines or renal imaging UTI in hospitalised children

Dear Editor

The original article gives a message of caution in the use of Renal Ultrasound as a preliminary test in deciding on a V(M)CUG test to diagnose VUR. The study looked at 2 definite investigations carried out in all children under the age of 1, however the RCPCH (UK) guidelines recommend DMSA, Renal U/S & MCUG in all children with a proven UTI under the age of 1.

The RCPCH (UK)guidelines for children between 1 and 7 years of age are to carry out Renal U/S, DMSA scan, Abdominal Xray & MCUG if either DMSA or Renal U/S are abnormal(or if there is positive family history/recurrent UTI/Pyelonephritis).

The age group studied in the Canadian children was under 5 years and the majority of those were under the age of 1 ( Note: Median age of the subjects: 85 days, with males being much younger than females presenting with symptomatic UTI and needing hospitalisation).

If the same study were applied to children with symptomatic UTI admitted to hospitals in the UK, all those under the age of 1 would need all 3 Renal Imaging investigations (i.e. Renal U/S, MCUG & DMSA scans) and the combination of Renal U/S & DMSA in 1-7 year olds, which will help decide the need for an MCUG.

There is no debate in that, the MCUG, is the best diagnostic test for the diagnosis of VUR, and that the Renal U/S has limitations in picking up anomalies of Renal Morphology (dilatation) suggestive of VUR. However, the combination of Renal U/S & DMSA scans should be more helpful.

This practical guideline in the UK may well lead to lesser number of MCUGs done in children over 1 and thereby reduce significantly the need for the invasive nature, infection risk & radiation exposure to all children who will have MCUGs done in Canada.