University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Is renal ultrasound necessary in the work-up for first febrile UTI in children between the ages of 2 and 24 months?
  

Clinical Bottom Lines

1. Renal ultrasound still necessary in work-up of first febrile UTI; no clear evidence that use of ultrasound does not change clinical outcome exists.

Summary of Key Evidence

1. The article appearing in the January 16, 2003 NEJM titled “Imaging Studies after a First Febrile Urinary Tract Infection in Young Children” asserts that renal ultrasound is not necessary and does not change clinical outcome.
   
2. They recommend not performing renal ultrasound in any children with first febrile UTI if there was a documented good quality prenatal ultrasound performed after 30 to 32 weeks gestation.
   
3. The study was not an RCT, which would be necessary to truly assert no difference in clinical outcomes.
   
4. Follow up was only 6 months, a much shorter time period than is needed to see the eventual outcomes of renal scarring, hypertension, or ESRD.
   
5. We really need evidence concerning the efficacy of prophylactic antibiotics for preventing the long-term outcomes of scarring, hypertension or ESRD.
   

Additional Comments

• Further study is needed before determining whether current guidelines regarding use of imaging studies in febrile UTI are effective in preventing adverse long term outcomes.
• We already know that renal ultrasound is not 100% sensitive in detecting reflux, which is why the AAP guidelines recommend VCUG as well.

Citation

1. Hoberman A, et al. Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 2003; 348:195-202.
2. Kass EJ, et al. Paediatric urinary tract infection and the necessity of complete urological imaging. BJU International 2000;86:94.
3. Roberts K. The AAP practice parameter on urinary tract infections in febrile infants and young children. American Family Pract 2000
   
4. Downs S. Technical report: Urinary tract infections in febrile infants and young children. Pediatrics 1999; 103:xxx-xx.
   

CAT Author: Andrea Nederveld, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: February 3, 2003