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There are many choices for imaging for pediatric patients with renal infections which include acute pyelonephritis, fungal infections, tuberculosis, xanthogranulomatous pyelonephritis, and renal abscess. The primary goal of imaging the most common form of infection, acute pyelonephritis, is the detection of anatomical risk factors for infection and for renal damage. Secondary goals are to confirm the diagnosis of acute pyelonephritis when the clinical presentation or urine culture results are equivocal, to detect renal scarring in select patients, and to assess renal function in damaged kidneys. Overall it is preferred by many in the pediatric population to begin with noninvasive, no radiation studies such as the ultrasound; however, the decreased accuracy of sonography for the detection of acute pyelonephritis and renal scarring limits its applicability. DMSA scans, CT scan, and MRI are generally equivalent in ability to detect renal parenchymal abnormalities beyond ultrasonic evaluation, but the argument ensues whether the long-term risk of radiation exposure in CT scans and DMSA scans is more of a concern than the costs and need for heavy sedation or anesthesia for MRI. Imaging of less common forms of renal infection varies according to clinical indications and availability of resources. |
