Ultrasonography results in the first urinary tract infection in childhood: Which age group should be screened?

Objective: Urinary tract infection (UTI) is one of the most common infections in childhood and is very important as it can cause hypertension and kidney failure. UTI can be the first sign of congenital anomalies of the underlying kidney and urinary tract. Although renal ultrasonography (US) is not invasive, and its cost and radiation is low, although it is an ideal imaging method to detect structural anomalies of the urinary system there is still no consensus on which age group US should be withdrawn in the first UTI. The aim of our study is to determine the frequency of urinary system anomaly in children who have undergone UTI for the first time between the ages of 0-18 and to reach a conclusion about which patient group should be screened with US. Materials and methods: Our study was carried out retrospectively in Adıyaman University School of Medicine, Department of Child Health and Diseases. In the study, belonging to 247 children in the 0-18 age group who were diagnosed with UTI for the first time at the Adıyaman Training and Research hospital, between January 2017 and September 2019, the age, gender, urine culture, complete urine analysis, complete blood count, urea, creatinine, creactive protein, if it'done Technico-99m dimercapto succinic acid scintigraphy (DMSA) scintigraphy with technetium-99 diethylene triamine pentaacetic acid (DTPA), voiding cystourethrography (VCUG) history was performed retrospectively. Results: Of the total patients, 57.5% were female and 42.5% were male. It was observed that the most common reason for the application was fever and restlessness, while the frequency of application increased with the complaint of fever in the UTI cases as the age increased. The most reproductive microorganism in urine culture was E. Coli and secondly, Klebsiella pneumonia. While the prevalence of non-E. Coli microorganisms was higher in the 0-6 month group, the frequency of E. Coli increased as the age progressed. Anomaly was detected in 35.6% of US's performed on 247 patients who had UTI for the first time. The most frequent anomaly was hydronephrosis. 84.6% of hydronephrosis cases were unilateral and 15.4% were bilateral. It was observed that hydronephrosis was mostly in the left kidney in the 0-6 month group and in the right kidney in the later age groups. E. Coli was detected as the causative pathogen in 62.5% of patients with anomaly detected in US. In the multi-directional regression analysis, the detection of anomaly in US in the 0-5 age group was found to be an independent marker for predicting serious urinary system pathologies (OR: 8.312, %95CI 3.504 – 19.718, P<0.001). The sensitivity and specificity of ultrasonographic anomalies in predicting serious urinary system pathologies according to age groups are 63.64% and 77.14% in the 0-6 month group, 83.33% and 84.62% in the 6-24 month group and between 2-5 ages it was 80.00 and 82.93%. Conclusion: In our study, the detection of anomaly in US in the 0-5 age group was an independent marker in predicting serious urinary system pathologies. Based on these results, we think it would be beneficial to perform routine US screening in children under the age of 5 for the first time under UTI. Key words: Urinary tract infction, ultrasound, anomaliy, hydronephrosis