الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion 217
Summary And Conclusion
Urinary tract infection in children is a disease of major
concern as it causes morbidity and inconvenience to many
patients and may end up with end stage renal failure with
large financial burden on both the family and the society.
Clinical diagnosis of urinary tract infection can not be
relied upon. The symptoms and signs are rather non-specific
and may result in false-positive or false-negative diagnosis.
Appropriate management of urinary tract infection depends .
almost entirely on specific microbiologic studies and
radiologic imaging evaluation.
Microbiologically, the commonest causative pathogen
in the study was E. coli (99%) followed by proteus (15%),
staphylococCus aureus (13%), Klebsiella and Pseudomonas
(4 %) and Streptococcus (3 %).
All children with urinary tract infection require
imaging evaluation to determine those with or at risk for
sustaining renal scarring, it is advisable to perform the
imaging work-up following the first infection in both sexes .
especially for the younger age group at risk. This is in part
due to the fact that some children with urinary tract infection
have anomalies, principally vesicourete’ric reflux, often with
associated renal scarring. Because anomalies can not be
Summary and Conclusion 218
excluded clinically, it is advisable that all cases should be
imaged.
Ultrasonography and plain abdominal radiograph alone
are insufficient for routine screening of childhood urinary
tract infection. Though further investigations remain
adv~sable in infants, Le.· voiding cystourethrography and
static renal scintigraphy, in older children, they can be
restricted to a minority who have positive ultrasound
examination or have had fever and/or vomiting. This policy
minimizes the number of children requiring invasive
investigations while ensuring that consequential urinary
anomalies are rarely overlooked.
Renal scarring is best assessed by static renal scan
(DMSA) as it is the gold standard followed by US that has .
a sensitivity 100% and specificity 98%, then excretory
urography with a sensitivity 52.5% and specificity ~OO%.
Also dynamic diuresis renography (DTP A) is the best
in distinguishing obstructive from non obstructive uropathies
followed by US that has a specificity 100% and sensitivity
61 %, then EU with a specificity 96.5% and sensitivity 65%.
Therefore, US and radioisotopic examinations largely
eliminate the need for excretory urography, except in cases
of duplex system with ectopic ureter where the necessity for
excretory urography is undebated.
Summary and Conclusion 219
Follow-up of these cases with early onset of recurrent
urinary tract infection by repeated cultures, imaging,
medical and or surgical treatment can save many children
from progression to end stage renal disease. Measurement
of renal size and assessment of renal growth are important
parts of the radiologic evaluation of the urinary tract in
children. Sonography is now the standard technique for
evaluation of renal growth.
SonographiC measurement of renal length is used
commonly to evaluate growth of the kidneys in children.
Measurements of renal length on follow-up-sonograms (on
half yearly basis) are used to determine if renal growth in
the interval between examinations has been appropriate.
Comparing renal length with age is the easiest and the most
practical approach.
In the present study follow-up of renal length by
ultrasonography of 100 cases (half yearly for 2 years) were
recorded in follow-up curves compared to a normal renal
growth curve (Rosenbaum et at, 1984). It was found that
19 right kidneys and l8left kidneys showed retarded growth
in their follow-up curves. Positive correlation was found
between the early onset of 1st infection (especially before
first 2 years age) and renal growth retardation, as the more
rapid change in kidney size is during the first year of life.
It was found also that structural pathology and scar presence
Summary and Conclusion . 220
have a significant correlation with delayed (retarded) renal
growth.
We conclude that the diagnostic imaging techniques
for pediatric renal diseases have grown considerably in the
last decade and a variety of imaging modalities are available
today for investigating UTI in pediatric patients. Used
intelligently singly or in combination, these imaging
modalities provide information for the clinical evaluation as
well as short and long-term management of infections, their
causes, complications and their effects on renal function.
Repeated ultrasound examination is very important to
diagnose and emphasize renal scarring.
Apparent difference. in size between both kidneys
and/or between the kidney versus the normal on the standard
growth curve highlights further proceeding to radionuclide
scanning.
Ultrasonography has many advantages in comparison
to other imaging modalities. It is inexpensive, the child is .
not. exposed to ionizing radiation, also it is non invasive
procedure so can be performed on outpatient basis, i.e.
doesn’t require hospitalization before or after examination
and doesn’t require special preparation of the patient.
Moreover, it is easily and unharmfully repeatable.