Physicians shouldn’t hesitate in performing a voiding cystourethrogram (VCUG) on young children admitted to the hospital for urinary tract infections (UTI) following the initiation of antibiotic therapy, suggests a study from Nationwide Children’s Hospital. The study is the first to suggest that early VCUG testing does not cause significant health morbidity.
UTI is one of the most common and serious types of bacterial infection in children. In 1999, the American Academy of Pediatrics issued practice guidelines for the management of UTI which recommended that young children diagnosed with their first UTI undergo a renal ultrasound and VCUG in order to check for the presence of anatomic abnormalities and vesicoureteral reflux (VUR). The combination of VUR and UTI may predispose children to pyelonephritis, renal scarring, hypertension and chronic kidney disease.
Despite these recommendations, many children with a first UTI do not undergo VCUG testing. “Traditionally, there have been concerns about the accuracy and safety of a VCUG performed during an active infection,” said Andrew L. Schwaderer, MD, Nationwide Children’s nephrologist and one of the study authors. “Physicians often defer obtaining a VCUG after the diagnosis of urinary tract infection due to concerns regarding increased health risks and inflated rates of VUR. Many defer VCUG testing until the UTI resolves.”
To determine whether there are increased health risks associated with early VCUG testing in children with UTI, investigators from Nationwide Children’s performed a retrospective review of children admitted to the hospital with a febrile UTI. The 152 patient were grouped as those who underwent VCUGs during the inpatient admission and after being put on antibiotics (early group), or those who were scheduled to have a VCUG performed after being discharged from the hospital (late group).
Comparison showed that patients who had a VCUG performed within 7 days of UTI diagnosis did not have higher rates of VUR than those who underwent the procedure after the infection resolved. The incidence of VUR in this study was consistent with the rates of VUR seen in patients with a UTI during the first year of life. None of the inpatients who had early VCUG testing returned to the Nationwide Children’s Emergency Department, developed a subsequent UTI or were readmitted within a week of discharge.
“When combined with previously published studies, our data indicate that early VCUG testing does not overestimate the incidence of VUR in healthy children, does not increase the risk of bacterial dissemination or sepsis, nor does it lead to significant health risks in healthy children,” said Dr. Schwaderer.
Spencer JD, Bates CM, Mahan JD, Niland ML, Staker SR, Hains DS, Schwaderer AL. The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection. J Pediatr Urol. 2010 Dec 1. [Epub ahead of print]