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Children’s Hospital of Pittsburgh Researchers Find Tests for Urinary Tract Infection Unnecessary

Researchers at Children’s Hospital of Pittsburgh have shown that specific imaging tests routinely performed in children following urinary tract infections may be unnecessary, according to an article in today’s New England Journal of Medicine.

The Children’s team, led by pediatrician Alejandro Hoberman, MD, chief of General Academic Pediatrics, found that renal ultrasonograms – routinely performed on young children with urinary tract infections – often are of limited value. View the paper in its entirety.

“For decades, clinicians have followed urinary tract infections in children with tests that are expensive, time-consuming and sometimes uncomfortable,” Dr. Hoberman said. “Our results show that many of these tests are unnecessary because they do not modify management.”

Urinary tract infection is the most common serious bacterial infection in young children. About 60 percent of these infections are in the kidney, which can lead to renal scarring and long-term consequences such as hypertension and complications during pregnancy.

Performing an ultrasonogram and a voiding cystourenthrogram is recommended for children with a urinary tract infection in guidelines published by the American Academy of Pediatrics. Using additional kidney scans to detect kidney infection or renal scarring also is endorsed by other authorities.

“These recommendations don’t take into account the fact that prenatal ultrasounds are routine now,” said Ellen Wald, a co-investigator and chief of Allergy, Immunology and Infectious Diseases at Children's. “If an ultrasonogram is performed after 30-32 weeks gestation at a reputable institution, kidney abnormalities most likely will be diagnosed before birth.”

Children’s researchers analyzed data from a large, previously conducted clinical trial to determine whether certain imaging studies altered treatment or improved the outcomes for young children with a first-time urinary tract infection. Results of renal ultrasonograms were normal in 88 percent of the 309 children who received the tests and abnormalities identified did not modify treatment. Approximately 40 percent of children had backflow of urine from the bladder into the kidney, which increases the risk of repeated kidney infections.

Conducting imaging tests to detect reflux continues to be recommended under the assumption that drug therapy is effective in reducing subsequent re-infections and renal scarring. The need for additional kidney scans either at the time of acute infection or 6 months later, may be eliminated if urinalysis and/or urine culture becomes routine in all children with a previous urinary tract infection who develop fever, the Children’s researchers found. However, Dr. Hoberman said that a renal ultrasound continues to be required if a child has a persistent fever; a delayed response to treatment with antibiotics; or if the prenatal ultrasound was done before 30 weeks of pregnancy.

Contact:
Marc Lukasiak or Melanie Finnigan, 412-692-5016,
Marc.Lukasiak@chp.edu or Melanie.Finnigan@chp.edu

Last Update
February 20, 2008
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Last Update
February 20, 2008
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