Evidence Based Medicine

Post-UTI Renal US
Amna Abdalla
Amna AlNakhi
Hafsa Ahmed
Bassam Tariq

Objectives
Introduction & Aim
 PICO
 Level of evidence
 Methods
 Results
 Good and Bad things about the article

Amna Abdalla

INTRODUCTION & AIM

Article

Achieves of Disease in Childhood

2007

Introduction

UTI is relatively prevalent in children, affecting 3–5% of
females and 1.5% of males.
Purpose of RUS post-UTI is to detect urinary tract
abnormalities:
 Vesicourethral reflux (VUR)
 Obstruction of the urinary tract
 Ureterocele
 Renal scarring
Aim: asses the concordance of late pregnancy and postUTI renal ultrasonogram in children with first proven
simple UTI.

PICO Format

P

Children ≤5 years old with proven UTI

I

Post-UTI Renal Ultrasonogram

C

Ante-natal Renal Ultrasonogram

O

Post-UTI RUS findings

Level of Evidence
Level IIb
 Prospective Cohort Study

Amna AlNakhi

METHODS
)ِِA PROSPECTIVE STUDY)

Study Patients
 Children aged 5 years or less.

Hospitalized with first simple UTI (determined as clinical response
and normalization of temperature within 48 h on initiation of
antibacterial therapy with no complications).

RUS & voiding-CUG performed within 6 weeks of discharge.

Data were collected regarding the results of prenatal and post-UTI
RUS.

Grading of the RUS findings were divided into mild, moderate &
severe pelvic dilation.

An informed consent was obtained form the parents/guardians.

Statistical Analysis

A 95% confidence intervals (95% CI)
calculated for the predictive value of
normal prenatal to normal post-UTI
RUS were calculated using the SPSS
11.5 statistical package tests.

Hafsa Ahmed

RESULTS

Results
250 patients  209 used
 209  10 non-simple UTI with
immediate Renal US  Pre and Post
UTI US results normal
 199 Pts  Normal Pre/Post Renal
US

 Predictive

99%)

value 96% (95% CI: 93% -

Results

3 with Pre UTI Renal US  Kidney
anomalies

Anomaly was not found in 1 pt with Post UTI RUS

9 with Post UTI Renal US  Kidney
anomalies

2 had anomaly on Pre UTI RUS

Pre UTI
RUS

1

2

7

Post UTI RUS

Results

Voiding Cystourethrography (VCUG)
 57 patients (78 Kidneys) with
vesicourethral reflux.
 97%

Normal Pre- UTI RUS
 90% Normal Post – UTI RUS
 Predictive value of Normal Pre- UTI
RUS to Normal VCUG  73.3% (95%
CI: 67% to 95%)

Bassam Tariq

PROS & CONS

Good things about the article

The study addressed a focused issue .

The type of the study : Prospective study with single
blinding

The use of strict clinical criteria for the assignment of
the study sample

Complete concordance between pre- and postnatal
RUS was documented in (96%) of the children

All clinically important outcomes were considered

Bad things about the article

No randomization

Included all children aged 5 years or
younger

No 100% sensitive screening
modality is used in the study

THANK YOU