CTU Without and With IV Contrast There is no relevant literature to support the use of CTU in the evaluation of a child with atypical or recurrent febrile UTI for initial imaging. DMSA Renal Scan A DMSA renal scan may have limited benefit in patients with VUR and atypical, complicated, or recurrent UTIs. A normal DMSA scan in patients with recurrent infections may exclude high-grade reflux on VCUG and thus direct toward antibiotic treatment without the need for invasive VCUG. The NICE guidelines recommend DMSA renal scan 4 to 6 months after atypical or recurrent infection (<3 years) and for recurrent infection (>3 years) in children [83]. The literature in this patient population is evolving with a focus on other modalities such as VUS and fluoroscopy VCUG. It should be noted that the primary evidence supporting use of DMSA renal scan is generally older than that of other modalities. Fluoroscopy Voiding Cystourethrography Children with recurrent UTIs have an increased prevalence of VUR [43]. Based on multiple studies in a pooled cohort of infants after first UTI and recurrent UTI, the frequency of VUR increases from 35% to 74%, with increased risk for renal scarring with each UTI [1]. A finding of VUR without dilatation of urinary tract may lead to antibiotic prevention treatment, and a finding of dilated VUR may lead to endoscopic or surgical treatment. VCUG is routinely performed for children <6 months of age with atypical UTI and from 6 months to 3 years of age with atypical UTI and abnormalities on renal and bladder US, poor urine flow, or family history of VUR as per the NICE guidelines Urinary Tract Infection-Child [83]. VCUG is not recommended by NICE guidelines for children >3 years of age with UTI, even if atypical or recurrent UTI [16]. The AAP guidelines suggest VCUG for children 2 to 24 months of age after the second febrile UTI and after the first for patients with abnormalities on renal and bladder US [41].
Urinary Tract Infection Child. CTU Without and With IV Contrast There is no relevant literature to support the use of CTU in the evaluation of a child with atypical or recurrent febrile UTI for initial imaging. DMSA Renal Scan A DMSA renal scan may have limited benefit in patients with VUR and atypical, complicated, or recurrent UTIs. A normal DMSA scan in patients with recurrent infections may exclude high-grade reflux on VCUG and thus direct toward antibiotic treatment without the need for invasive VCUG. The NICE guidelines recommend DMSA renal scan 4 to 6 months after atypical or recurrent infection (<3 years) and for recurrent infection (>3 years) in children [83]. The literature in this patient population is evolving with a focus on other modalities such as VUS and fluoroscopy VCUG. It should be noted that the primary evidence supporting use of DMSA renal scan is generally older than that of other modalities. Fluoroscopy Voiding Cystourethrography Children with recurrent UTIs have an increased prevalence of VUR [43]. Based on multiple studies in a pooled cohort of infants after first UTI and recurrent UTI, the frequency of VUR increases from 35% to 74%, with increased risk for renal scarring with each UTI [1]. A finding of VUR without dilatation of urinary tract may lead to antibiotic prevention treatment, and a finding of dilated VUR may lead to endoscopic or surgical treatment. VCUG is routinely performed for children <6 months of age with atypical UTI and from 6 months to 3 years of age with atypical UTI and abnormalities on renal and bladder US, poor urine flow, or family history of VUR as per the NICE guidelines Urinary Tract Infection-Child [83]. VCUG is not recommended by NICE guidelines for children >3 years of age with UTI, even if atypical or recurrent UTI [16]. The AAP guidelines suggest VCUG for children 2 to 24 months of age after the second febrile UTI and after the first for patients with abnormalities on renal and bladder US [41].