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DOI: 10.1055/s-0031-1277212
© Georg Thieme Verlag KG Stuttgart · New York
Experience with the NICE Guidelines for Imaging Studies in Children with First Pyelonephritis
Publikationsverlauf
received April 02, 2011
accepted after revision April 07, 2011
Publikationsdatum:
15. Juni 2011 (online)
![](https://www.thieme-connect.de/media/ejps/201105/lookinside/thumbnails/10.1055-s-0031-1277212-1.jpg)
Abstract
Purpose: This retrospective study evaluates the applicability of a selective approach for imaging in children aged 0–15 years with a first episode of pyelonephritis, based on the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE).
Material and methods: A total of 96 consecutive patients were included (age range: 0.1–14.9 years, median age: 0.7 years), treated for a first episode of confirmed culture-positive pyelonephritis. At initial hospitalization all patients underwent ultrasound examination of the kidneys and urinary tract (US) and technetium-99m mercaptoacetyltriglycine scinti- and renography (99mTc MAG3). If vesicoureteral reflux (VUR) was suspected, then prophylactic antimicrobial therapy was prescribed and the patients were referred to a surgeon for further evaluation including voiding cystoureterography (VCU). Patients with known urological anomalies including antenatally diagnosed anomalies were excluded. All patients were followed up for a median of 5.2 years (3.5–8.6 years).
Results: Initially, US findings were abnormal in 29 (30%) patients and 99mTc MAG3 findings were abnormal in 20 (21%) cases. At follow-up, prophylactic antimicrobial therapy was prescribed for 19 (20%), and VUR was diagnosed by VCU in 9 patients. Surgery was carried out in 7 (7%) patients, primarily for VUR. If the NICE guidelines had been initially followed, 5 of our 9 patients with VUR would not have been identified. VUR surgery was performed in 4 of these cases. Moreover, 9 cases with urological anomalies subsequently prescribed prophylactic antimicrobial therapy would have been missed.
Conclusion: We do not recommend following the imaging strategies of the NICE guidelines for children with a first episode of pyelonephritis. Our most important argument is that at follow-up, after a minimum of 3.5 years, the initial diagnosis of VUR would have been missed in 4 out of the 5 patients who underwent VUR surgery.
Key words
urinary tract infections - pyelonephritis - vesicoureteral reflux - congenital urological malformations - diagnostic imaging
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Correspondence
Dr. Jørgen Thorup
Rigshospitalet
4272 Paediatric Surgery
9 Blegdamsvej
2100 Copenhagen
Denmark
Telefon: +45 4035 83 64
Fax: +45 3545 38 88
eMail: joergen.thorup@rh.regionh.dk