Based on the results of a simple urine test, the diagnosis of a urinary tract infection (UTI) in your young child can bring with it relief and confusion. Finally, you have an explanation for the fever, vomiting, irritability, and lethargy. A short course of antibiotics is often all that is needed to clear up the infection and get your child back on the path to good health. Most likely, though, the physician will order a battery of tests to gather more information about your child's urinary system, as has been recommended for years by the American Academy of Pediatrics. Here is where the confusion may set in.
The tests typically ordered for a young child with a first UTI include a voiding cystourethrogram (an x-ray test that helps evaluate the function of the bladder during urination), an ultrasound of the kidney, and oftentimes a scanning test that shows the shape and function of the kidney. The diagnostic tests can identify abnormalities in a child's urinary system that would lead to recurrent infections. The tests may also show scarring, which is associated with health problems later in life, such as high blood pressure or kidney failure. But are all these tests really necessary after one infection? A study published in the New England Journal of Medicine set out to answer this question.
In the study, over 300 children between the ages of one month and two years who were diagnosed with their first UTI underwent an ultrasound, kidney scan, and voiding cystourethrogram. Ultrasound results were abnormal in only 12% of the children and these findings did not lead to any changes in the treatment of the children's infections. The kidney scans showed 61% of the children had inflamed kidneys at the time of the UTI, as is expected with such an infection. Follow-up scans six months after the infection showed scarring in the kidneys of 9% of the children. The cystourethrograms showed 39% of the children had vesicoureteral reflux, a condition in which urine backwashes out of the bladder back up into the kidneys, leading to infection and tissue damage. The condition was mild in 96% of these children.
These results suggest some changes in the standard protocol for dealing with UTIs in young children. According to the researchers, kidney ultrasounds and scans at the time of a first infection are not necessary, because these tests do not provide any information that changes initial treatment of the illness. The voiding cystourethrogram may remain an important diagnostic test for children with a first infection because of its ability to detect vesicoureteral reflux. Children with this condition are often prescribed long-term antibiotic treatment under the unproven assumption that it prevents reinfection and scarring.
If your young child is diagnosed with a UTI, talk with the physician about the results of this study and what diagnostic tests are necessary. Your primary concerns should be how to effectively treat the infection and prevent reinfection. You may want your child to undergo a voiding cystourethrogram at the time of infection to determine if he or she suffers from vesicoureteral reflux and is likely to have recurrent infections.
April 2004 Update