Background: The strong association between kidney and urinary tract anomalies and childhood urinary tract infection (UTI) often leads to imaging tests being performed. -Objective: To describe the epidemiology, characteristics, and imaging findings in Thai children with UTI and compare results between boys and girls. Methods: We retrospectively reviewed the medical records of children with UTI aged < 15 years. Demographic characteristics and findings of investigations are presented. Results: One hundred seventy-eight boys and 170 girls with 432 UTI episodes were identified. The median (interquartile range) age at presentation was 1.4 (0.6–3.4) years, 1.0 for boys and 2.1 for girls (p < 0.001). Renal ultrasound, voiding cystourethrogram and 99mTc dimercaptosuccinic acid (DMSA) renal scans were performed in 273, 223 and 113 children, respectively. Overall, 283 children (81.3%) had at least one imaging study done and anomalies of the kidney and urinary tract were detected in 158 (45.4%). Primary vesicoureteral reflux was detected in 73 (32.7%) children. The remaining abnormalities were hydronephrosis (n = 54). DMSA scans detected 54 children with dysplastic or scarred kidneys. Conclusions: First UTI in a group of Thai children occurred in approximately equal proportion in boys and girls but boys were younger at diagnosis. Kidney and urinary tract anomalies were detected in half of the children.

Keywords:
Congenital anomalies of the kidney and urinary tract, Urinary tract infection, Vesicoureteral reflux
1.
Millner R, Becknell B. Urinary Tract Infections.
Pediatr Clin North Am
. 2019 Feb; 66(1): 1–13.
2.
Pohl HG, Belman AB. Congenital anomalies of the urinary tract.
Curr Pediatr Rev
. 2014; 10(2): 123–32.
3.
Soliman NA, Ali RI, Ghobrial EE, Habib EI, Ziada AM. Pattern of clinical presentation of congenital anomalies of the kidney and urinary tract among infants and children.
Nephrology (Carlton)
. 2015 Jun; 20(6): 413–8.
4.
Costantini E, Illiano E, Giannitsas K, Prestipino M, Pastore AL, Carbone A, et al. Urological dysfunction in young women: an inheritance of childhood?
BJU Int
. 2018 Mar; 121(3): 453–7.
5.
Nakai H, Asanuma H, Shishido S, Kitahara S, Yasuda K. Changing concepts in urological management of the congenital anomalies of kidney and urinary tract, CAKUT.
Pediatr Int
. 2003 Oct; 45(5): 634–41.
6.
National Institute for Health and Clinical Excellence. Urinary tract infection in children. London: NICE; 2007. Available from: http://guidance.nice.org.uk/CG054.
7.
Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management, Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.
Pediatrics
. 2011 Sep; 128(3): 595–610.
8.
van der Watt G, Omar F, Brink A, McCulloch M. Laboratory investigation of the child with suspected renal disease. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL, editors.
Pediatric Nephrology
. 7th ed. Heidelberg: Springer-Verlag, Berlin; 2016. pp. 613–36.
9.
Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology.
Pediatr Radiol
. 1993; 23(6): 478–80.
10.
Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children.
Pediatr Radiol
. 1985; 15(2): 105–9.
11.
Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Roca I, et al. Guidelines for 99mTc-DMSA scintigraphy in children.
Eur J Nucl Med
. 2001 Mar; 28(3):BP37–41.
12.
Freedman AL. Urologic Diseases in America Project. Urologic diseases in North America Project: trends in resource utilization for urinary tract infections in children.
J Urol
. 2005 Mar; 173(3): 949–54.
13.
Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis.
Pediatr Infect Dis J
. 2008 Apr; 27(4): 302–8.
14.
Zelikovic I, Adelman RD, Nancarrow PA. Urinary tract infections in children. An update.
West J Med
. 1992 Nov; 157(5): 554–61.
15.
Smellie JM, Normand IC. Urinary infections in children 1985.
Postgrad Med J
. 1985 Oct; 61(720): 895–905.
16.
Pennesi M, L’Erario I, Travan L, Ventura A. Managing children under 36 months of age with febrile urinary tract infection: a new approach.
Pediatr Nephrol
. 2012 Apr; 27(4): 611–5.
17.
Tullus K. What do the latest guidelines tell us about UTIs in children under 2 years of age.
Pediatr Nephrol
. 2012 Apr; 27(4): 509–11.
18.
Miron D, Daas A, Sakran W, Lumelsky D, Koren A, Horovitz Y. Is omitting post urinary-tract-infection renal ultrasound safe after normal antenatal ultrasound? An observational study.
Arch Dis Child
. 2007 Jun; 92(6): 502–4.
19.
Preda I, Jodal U, Sixt R, Stokland E, Hansson S. Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection.
J Pediatr
. 2007 Dec; 151(6): 581–4, 584.e1.
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2019
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