Assessment of infective urinary tract disorders

Urinary tract infection (UTI) is common in children, particularly in the yo ungest age groups. There is a risk for progressive deterioration of renal f unction in these children if aggravating factors such as gross reflux and/o r outflow obstruction of the urinary tract are present. In this review the pros and cons of available scintigraphic and radiological imaging technique s for the work-up of these children are presented. Ultrasound can be used i n the acute phase to exclude obstruction but can not reliably show transien t or permanent parenchymal lesions. The presence of reflux can be establish ed with X-ray or direct nuclide cystography. The X-ray technique gives good morphological information and has a grading system with prognostic relevan ce. Both techniques are invasive and great care must be taken to keep the r adiation burden down with the X-ray technique. Indirect nuclide cystography following a renographic study is non-invasive but has a lower sensitivity than direct techniques. More experience is needed with the indirect techniq ue to evaluate the consequences of its apparently low sensitivity. Urograph y has a limited place in the acute work-up of urinary tract infection but c an be used to look for renal scarring 1-2 years after an acute pyelonephrit is. The Tc-99m dimercaptosuccinic acid (DMSA) scan can be used during the a cute UTI to show pyelonephritic lesions with good accuracy and/or during th e follow-up after six months to show permanent lesions. The acute DMSA scan can be omitted. An early treatment is more important than an early scan!