ESPN 50th Annual Meeting

ESPN 2017


 
Renal Tract Abnormalities Missed In A Historical Cohort Of Young Omani Children With UTI, If The NICE And AAP Imaging Guidelines Were Applied
Mohamed El-Naggari 1 Sharef Al-Mulaabed 2 Ibtisam Elnour 1

1- Sultan Qaboos University Hospital, Muscat, Oman
2- Brookdale University Hospital, New York, USA.
 
Introduction:

Urinary tract infection (UTI) in pediatrics, especially acute pyelonephritis (APN), are susceptible to renal scarring that is associated with long-term complications such as hypertension, proteinuria, and reduced renal function. the United Kingdom (UK) presented new guidelines for imaging procedures for UTI but without providing levels of evidence. The American Academy for Pediatrics (AAP) published revised guidelines for children, including levels of evidence grading. We are unsure which guidelines is suitable for Omani children.

Material and methods:

A retrospective analysis of children below 14 years with UTI between 1992-2010, who underwent full investigation at SQUH according to Royal College of Physician (RCP). 303 children were evaluated for inclusion in the study. Out of them, 298 children had completed the data and the required investigations. We calculated the proportion of abnormalities which would have been missed had the new guidelines from the National Institute for Health and Care Excellence (NICE)  in UK or AAP, been used instead.

Results:

Out of all patients,  49 (16%) male, 249 (84%) female, 191 (64%) had recurrent UTI. On the other hand, atypical UTI was present in 116 (39%) patients. E coli in the urine was found in 206 (69%) of the patients, while the other 92 (31%) had non E coli organisms. Hydronephrosis was the most prevalent US finding (in 49 patients)

Percentage of abnormalities potentially missed.
  NICE AAP
HYDRONEPHROSIS 14% 0%
VESICO-URETERIC REFLUX 74% 85%
RENAL SCARRING 33% 42%
DECREASE RENAL UPTAKE 38% 40%

 

 

Conclusions:

The prevalence of renal tract abnormalities missed by the new guidelines is high. They should be used with full awareness of their limitations and this should be carefully balanced against using the prior guidelines, that advocate more use of US, VCUG, and DMSA scintigraphy, which are costly, time-consuming, sometimes unpleasant, and associated with radiation exposure as well as prolonged clinic follow-up visits.