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Old 05-30-2011
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Kidney Imaging Follow up of UTI

Can someone please explain to me when to do imaging after a UTI and the sequence of the studies?

I keep finding different recommendations and it is so confusing!

thanks
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Old 05-30-2011
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Correct Answer

When symptoms of cystitis/pyelonephritis are clear, there is no need for imaging studies. Just do a urinalysis and urine culture and start the Empiric treatment.
Imaging studies are done if there are frequent episodes of UTI or no response to empiric antibiotics AFTER 48-72hrs.
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Old 05-30-2011
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Thank you for your reply.

I should have mentioned that I'm talking about children not adults.
When to do US, VCUG, DMSA?

And regarding adults, I think men must always get further evaluation after a UTI/Pyelonephritis? please correct me

Last edited by soulhead; 05-30-2011 at 11:46 AM. Reason: typo
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Quote:
Originally Posted by soulhead View Post
Thank you for your reply.

I should have mentioned that I'm talking about children not adults.
When to do US, VCUG, DMSA?

And regarding adults, I think men must always get further evaluation after a UTI/Pyelonephritis? please correct me
Anatomic abnormalities are much more common in men with UTIs which can be detected by imaging studies. But still for any UTI :
best initial test: urinalysis
most accurate test: urine culture

In children, its a little tricky:


The following types of pediatric patients should undergo ultrasonography / voiding cystourethrography (VCUG) after a first febrile UTI:
  1. Those in whom treatment fails after 48-72 hoursPatients with an abnormal voiding pattern (dribbling of urine)
  2. Infants and children in whom good follow-up is not assured
  3. Those with an abdominal mass
  4. Infants and children with recurrence of a febrile UTI


The following types of pediatric patients do not need imaging studies after a first UTI:
  1. Infants and children with a first febrile UTI who are assured follow-up, who respond promptly to treatment (afebrile within 72 h), and who have a normal voiding pattern (no dribbling) and no abdominal mass
  2. Infants and children with cystitis

source: http://emedicine.medscape.com/article/969643-overview
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Old 05-30-2011
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Thank you dude
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Correct Answer

Quote:
Originally Posted by soulhead View Post
Thank you for your reply.

I should have mentioned that I'm talking about children not adults.
When to do US, VCUG, DMSA?

And regarding adults, I think men must always get further evaluation after a UTI/Pyelonephritis? please correct me
All children need VCUG after first febril UTI except girls older than 5 years old with first UTI
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Old 05-30-2011
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I agree this is a confusing subject. Fear not. It's confusing because the experts do not agree on one universal approach. That's why you see inconsistent recommendations. I found the following on UpToDate:

-Girls younger than three years of age with a first UTI
-Boys of any age with a first UTI
-Children of any age with a febrile UTI
-Children with recurrent UTI (if they have not been imaged previously)
-First UTI in a child of any age with a family history of renal disease, abnormal voiding pattern, poor growth, hypertension, or abnormalities of the urinary tract

Even this is considered a "Grade 2C" recommendation, meaning:

2. Weak recommendation: Benefits and risks closely balanced and/or uncertain
C. Low-quality evidence: Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

Basically you will not find one universally agreed upon recommendation because it does not exist. If you do get a question on this, it is likely that they will make the situation unambiguous, since the guidelines are controversial.
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Old 02-24-2012
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Default But When?

Hi,

I just want to ask if anyone knows WHEN these imaging studies are performed? I mean a VCUG and DMSA is to assess any renal scarring or anatomical abnormalities right? So do we wait until the UTI has subsided ie as an outpatient, or perform the imaging studies while the patient is in hospital for their treatment?

D
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