Value of ultrasonography in evaluation of children with urinary tract infection

ABSTRACT

One hundred and twelve children with proven urinary tract infection [UTI] were enrolled in this study. Their ages ranged between 4 weeks to 13 years [mean of 5.2 years]. Both sexes were included [33 males and 79 females]. For all children renal ultrasonography [US], intravenous pyelography [IVP] and voiding cystourethrography [VCUG] were performed and the results were compared and discussed. No pathological findings were detected by any of the 3 means in 72 cases [64.3 percent], while functional or anatomical abnormalities were seen in 40 cases [35.7 percent] by one or more of the 3 imaging techniques. Vesicoureteral reflux was detected in 23 cases [57.5 percent of the total pathologic findings], and other lower urinary tract pathologies in 5 cases [12.5 percent].US and IVP were well correlated in 103 of the 112 patients [91.96 percent]. In the remaining 9 children in whom there was a discrepancy between the two diagnostic modes US failed to detected findings that were noted by IVP in 6 cases with considerably negligible findings in absence of reflux, while IVP failed to detect the diffuse parenchymal disease revealed by US in 2 cases. The 9[th] case showed false positive findings in US. We also documented a significant volume increase in one or both kidneys with acute infection [detected by US] in children having an upper urinary tract infection [UUTI]. All children [except one] classified as having UUTI had renal volume of [+1 SD] of the mean of control group, 83 percent of them had hugely enlarged kidneys [+2 SD] while only 2 children with lower urinary tract infection [LUTI] had unilateral renal volume increase of+1 SD. So, we conclude that US can replace IVP in the initial screening of children with UTI, to be followed by VCUG. IVP is done only whenever more anatomical visualisation of the upper urinary tract is required