Routine diagnostic imaging for childhood urinary tract infections: a systematic overview.

OBJECTIVE To assess the quality of the evidence on which current recommendations for routine diagnostic imaging for childhood urinary tract infection are based. METHODS A systematic overview of the literature using the MEDLINE database (1966 to October 1994), article bibliographies, and a manual search of current publications using Current Contents, was undertaken. Preset criteria were used to categorize study sample and design, and interrater reliability was assessed with a random sample. RESULTS A total of 434 publications were evaluated, and 63 studies met the criteria for inclusion. There was 100% interrater agreement on inclusion eligibility and design classification. No controlled trials or analytic studies evaluating routine diagnostic imaging were found. All 63 studies were descriptive, and only 10 were prospective. None of the studies provided evidence of the impact of routine imaging on the development of renal scars and clinical outcomes in children with their first urinary tract infection. CONCLUSION Methodologically sound, prospective studies are needed to assess whether children with their first urinary tract infection who have routine diagnostic imaging are better off than children who have imaging for specific indications. We conclude that the current recommendations are not based on firm evidence.

[1]  M. Hertz,et al.  Imaging of children with urinary tract infection: a tailored approach. , 1989, Clinical radiology.

[2]  J. Guignard,et al.  Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. , 1975, Pediatrics.

[3]  M. Rossleigh,et al.  Evaluation of acute urinary tract infection in children by dimercaptosuccinic acid scintigraphy: a prospective study. , 1992, The Journal of urology.

[4]  B. Arant.  Vesicoureteric reflux and renal injury. , 1991, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[5]  Fryback Dg.  A conceptual model for output measures in cost-effectiveness evaluation of diagnostic imaging. , 1983 .

[6]  S. Hansson,et al.  Trimethoprim-sulphadiazine prophylaxis in children with vesico-ureteric reflux. , 1989, Scandinavian journal of infectious diseases.

[7]  B. Churchill,et al.  Acquired renal scars in children. , 1983, The Journal of urology.

[8]  I. Verber,et al.  Serial 99mTc dimercaptosuccinic acid (DMSA) scans after urinary infections presenting before the age of 5 years. , 1989, Archives of disease in childhood.

[9]  J. Strife,et al.  Urography and voiding cystourethrography: findings in girls with urinary tract infection. , 1987, AJR. American journal of roentgenology.

[10]  W. Hendren.  Posterior urethral valves in boys. A broad clinical spectrum. , 1971, The Journal of urology.

[11]  R. Drachman,et al.  Excretory Urography and Cystourethrography in the Evaluation of Children with Urinary Tract Infection , 1984 .

[12]  P. Crome,et al.  Letter: Paracetamol hepatoxicity. , 1976, Lancet.

[13]  M. Broyer,et al.  Chronic Renal Failure in Children , 1973 .

[14]  R. Weiss,et al.  Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The International Reflux Study in Children. , 1992, The Journal of urology.

[15]  J. Lohr,et al.  Prevention of recurrent urinary tract infections in girls. , 1977, Pediatrics.

[16]  N. Slade,et al.  Late results in the management of primary pelvic hydronephrosis. , 2008, British journal of urology.

[17]  R. White,et al.  Renal scarring and vesicoureteric reflux. , 1978, Archives of disease in childhood.

[18]  R. Grüneberg,et al.  CONTROLLED TRIAL OF PROPHYLACTIC TREATMENT IN CHILDHOOD URINARY-TRACT INFECTION , 1978, The Lancet.

[19]  J. Conway,et al.  Evolving role of nuclear medicine for the diagnosis and management of urinary tract infection. , 1994, The Journal of pediatrics.

[20]  P. Puri,et al.  Endoscopic correction of primary vesicoureteric reflux: results in 94 ureters. , 1986, British medical journal.

[21]  D. Leighton,et al.  Obstruction in the refluxing urinary tract--a common phenomenon. , 1989, Clinical radiology.

[22]  G. Johnson.  Development of renal scars in children: missed opportunities in management. South Bedfordshire Practitioners' Group. , 1990, BMJ.

[23]  L. Lins,et al.  Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. , 1989, BMJ.

[24]  S. Agarwal,et al.  Letter: Alpha-fetoprotein in Indian childhood cirrhosis. , 1974, Lancet.

[25]  J. Duckett,et al.  Posterior urethral valves, unilateral reflux and renal dysplasia: a syndrome. , 1982, The Journal of urology.

[26]  A. Retik,et al.  Urinary levels of the renal tubular enzyme N-acetyl-beta-D-glucosaminidase in unilateral obstructive uropathy. , 1994, The Journal of urology.

[27]  E. Stokland,et al.  The natural history of bacteriuria in childhood. , 1997, Infectious disease clinics of North America.

[28]  O. Koskimies,et al.  THE VALUE OF LEVEL DIAGNOSIS OF CHILDHOOD URINARY TRACT INFECTION IN PREDICTING RENAL INJURY , 1981, Acta paediatrica Scandinavica.

[29]  T. Barratt,et al.  Long-term outcome of boys with posterior urethral valves. , 1988, British journal of urology.

[30]  S. Shapiro,et al.  Pelvic hydronephrosis in children: a review of 219 personal cases. , 1977, The Journal of urology.

[31]  J R Thornbury,et al.  Eugene W. Caldwell Lecture. Clinical efficacy of diagnostic imaging: love it or leave it. , 1994, AJR. American journal of roentgenology.

[32]  J. Smellie,et al.  Children with urinary infection: a comparison of those with and those without vesicoureteric reflux. , 1981, Kidney international.

[33]  I. Wikstad,et al.  Renal scars and parenchymal thinning in children with vesicoureteral reflux: a 5-year report of the International Reflux Study in Children (European branch). , 1992, The Journal of urology.

[34]  R. Hohenfellner,et al.  Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension. , 1989, European urology.

[35]  P. Merguerian,et al.  Radiographic and serologic correlates of azotemia in patients with posterior urethral valves. , 1992, The Journal of urology.

[36]  C. Bratt,et al.  Maximum urinary concentration ability in patients with idiopathic hydronephrosis. , 1979, British journal of urology.

[37]  P. Puri,et al.  Urinary levels of N-acetyl-beta-D-glucosaminidase: a simple marker for predicting tubular damage in higher grades of vesicoureteric reflux. , 1994, European urology.

[38]  D. Tappin,et al.  A Prospective Study of Children with First Acute Symptomatic E. coliUrinary Tract Infection Early 99mTechnetium Dimercaptosuccinic Acid Scan Appearances , 1989, Acta paediatrica Scandinavica.

[39]  G. Mccracken,et al.  Urinary tract infections in young infants. , 1982, Pediatrics.

[40]  N. Prescod,et al.  Vesico-ureteric reflux and renal scarring. , 1975, Kidney international. Supplement.

[41]  J. D. Atwell.  Posterior urethral valves in the British Isles: a multicenter B.A.P.S. review. , 1983, Journal of pediatric surgery.

[42]  B. Lindblad,et al.  THE LONG TERM PROGNOSIS OF NON‐OBSTRUCTIVE URINARY TRACT INFECTION IN INFANCY AND CHILDHOOD AFTER THE ADVENT OF SULPHONAMIDES , 1969, Acta paediatrica Scandinavica.

[43]  H. N. Noe,et al.  Urinary N-acetyl-beta-glucosaminidase as a screening technique for vesicoureteral reflux. , 1994, Urology.

[44]  R. Smyth,et al.  Current practice in managing urinary tract infections in children. , 1988, BMJ.

[45]  A. W. Asscher,et al.  Covert bacteriuria: long term follow up. , 1991 .

[46]  K. Cartwright,et al.  Investigation of urinary tract infection in childhood. , 1993 .

[47]  A. Rickwood,et al.  Current imaging of childhood urinary infections: prospective survey. , 1992, BMJ.

[48]  J. Woodard,et al.  The Prognostic Significance of Fever in Childhood Urinary Infections , 1976, Clinical pediatrics.

[49]  M. Hellström,et al.  Fever, bacteriuria and concomitant disease in children with urinary tract infection. , 1989, The Pediatric infectious disease journal.

[50]  J. Winberg,et al.  EPIDEMIOLOGY OF SYMPTOMATIC URINARY TRACT INFECTION IN CHILDHOOD , 1974, Acta paediatrica Scandinavica. Supplement.

[51]  R. Filly,et al.  Development and progression of clubbing and scarring in children with recurrent urinary tract infections. , 1974, Radiology.

[52]  U. Berg,et al.  Long-term followup of renal morphology and function in children with recurrent pyelonephritis. , 1992, The Journal of urology.

[53]  H. Ozen,et al.  Does the severity of presentation in children with vesicoureteric reflux relate to the severity of the disease or the need for operation? , 1987, British journal of urology.

[54]  D. Drake,et al.  Hydronephrosis secondary to ureteropelvic obstruction in children: a review of 14 years of experience. , 1978, The Journal of urology.

[55]  J. Smellie,et al.  Urinary tract infection: a comparison of four methods of investigation. , 1995 .

[56]  W. Feldman,et al.  Methodologic limitations in the literature on vesicoureteral reflux: a critical review. , 1990, The Journal of pediatrics.

[57]  C. Marchant,et al.  Identification of children requiring radiologic evaluation for urinary infection. , 1985, Pediatric infectious disease.

[58]  J. Duckett,et al.  Protective factors in posterior urethral valves. , 1988, The Journal of urology.

[59]  N. Prescod,et al.  Disappearance of vesicoureteric reflux during long-term prophylaxis of urinary tract infection in children. , 1977, British medical journal.

[60]  N. Goldraich,et al.  Followup of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study. , 1992, The Journal of urology.

[61]  G. Howie,et al.  CONTROLLED TRIAL OF THERAPY IN COVERT BACTERIURIA OF CHILDHOOD , 1975, The Lancet.

[62]  W. Di,et al.  The prognosis of pelviureteric obstruction in childhood: a review of 190 cases. , 1976 .

[63]  I Gordon,et al.  Imaging in urinary tract infection. , 1991, Archives of disease in childhood.

[64]  T. Dolan,et al.  A survey of office management of urinary tract infections in childhood. , 1973, Pediatrics.

[65]  M. Hellström,et al.  Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection. , 1989, AJR. American journal of roentgenology.

[66]  U. Berg,et al.  Children with chronic renal failure in Sweden 1978–1985 , 1990, Pediatric Nephrology.

[67]  J. Smellie,et al.  Development of new renal scars: a collaborative study. , 1985, British medical journal.

[68]  D. Lenaghan,et al.  The natural history of reflux and long-term effects of reflux on the kidney. , 1976, The Journal of urology.

[69]  H. Ostensen,et al.  Intravenous urography in children and youth. , 1987 .

[70]  S. Koff.  Determinants of progression and equilibrium in hydronephrosis. , 1983, Urology.