Investigations depend on the age of the child, the severity of infection and past history. There is an international move towards a less invasive approach.
Ultrasound (US): Paediatric renal USS is available by direct GP referral to the Radiology department.
Acute US is indicated for:
Outpatient US within 6 weeks (unless done as an inpatient):
Follow-Up US one year later:
* Atypical UTI
Micturating Cystourethrogram (MCUG)
There is no evidence of benefit from detecting vesico-ureteric reflux (VUR) for the majority of children and for this reason MCU is no longer a routine recommendation. The request for an MCU should come from within hospital only.
MCU should be considered for:
A cystogram involves inserting a fine catheter into the child's bladder, filling the bladder with radiographic contrast, and taking sequential x-ray images. This is usually done under a light general anaesthetic, to reduce the stress to child and parent. In infants less than 3 months of age a cystogram is done under local anaesthetic only. The procedure usually takes less than 5 minutes. After recovery, the child is free to go home. Often the procedure is covered with oral antibiotics.
Nuclear medicine imaging is the most sensitive means of detecting renal parenchymal abnormalities. This investigation is performed in Hamilton.
Indications for DMSA scanning include:
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