Evaluation of Abnormal Radiological Findings in Children Under Five Years With Acute Pyelonephritis: A Retrospective Cohort Study

Background and Aim: Urinary tract infection is one of the most common infections inchildhood. The disease should not be overlooked because it has long-term complications suchas renal scarring and failure. We aimed to determine the relationships between radiologicalfindings in children under five years with acute pyelonephritis and its long-term complications.Methods: In this retrospective study, we reviewed the medical records of all childrenhospitalized with acute pyelonephritis in a two-year period. We studied, extracted, andanalyzed the imaging and demographic data of the patients.Results: Out of 210 available cases, 54 children with acute culture-positive pyelonephritiswere included. All the included cases had undergone ultrasound, Radionuclide Cystogram(RNC), Voiding Cystourethrography (VCUG) (for urinary reflux), and late DMSA(Dimercaptosuccinic Acid) scintigraphy. We found that 46.2% had Vesicoureteral Reflux(VUR), and 57.4% had an abnormal ultrasound, with hydronephrosis being the mostcommon finding (74.1%). We also found a significant correlation between ultrasound andVUR (P=0.002). About 37% also had abnormal DMSA scintigraphy. However, in those withnormal ultrasound results, 20% suffered from VUR, with one being severe. Seven cases alsohad abnormal DMSA scintigraphy.Conclusion: We demonstrated that a normal urinary ultrasound does not rule out thepossibility of VUR or the risk of progression to renal parenchymal dysfunction and scarring.Therefore, we suggest further utilizing the available radiologic techniques to diagnose andminimize subsequent renal complications in the disease promptly