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Pediatric and Adolescent Urologic Imaging pp 251–276Cite as

Renal Imaging: Infection

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Abstract

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.

Ultimately the advances in imaging modalities over the past few decades have undeniably influenced physician’s ability to successfully care for and treat their patients. The accuracy of imaging enables clinicians to diagnose and treat patients early in their course of disease. However, even with all of the changes, there are still differing philosophies regarding which tests should be performed and at what point in the course of treatment. The ideal imaging modality would be noninvasive, radiation-free, cost-efficient, without risk, and readily available in all areas of the country. In addition, it would be able to perform both anatomical and functional studies in one test and have randomized trials to prove its benefits over traditional imaging methods. Until the point in time where such an exam and clinical trials exist, we will have to rely on current and historical data evaluating sonography, DMSA, CT scans, and MRI for our current standard of care models.

In this chapter, the advantages, disadvantages, and findings of these imaging modalities are discussed for each type of renal infection. A summary of current treatment for each type of renal infection is also provided. Lastly, the late effects of renal infection including renal scarring, hypertension, and end-stage renal disease are summarized.

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Authors and Affiliations

  1. Department of Urology, George Washington University School of Medicine, Washington, DC, USA

    Dana C. Rice MD

  2. Section of Nuclear Medicine, Department of Radiology, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA

    Massoud Majd MD, FACR

  3. Radiology and Pediatrics, George Washington University School of Medicine, Washington, DC, USA

    Massoud Majd MD, FACR

  4. Division of Pediatric Urology, Children’s National Medical Center, 111 Michigan Avenue, NW, Washington, DC, 20010, USA

    H. Gil Rushton MD, FAAP

  5. Urology and Pediatrics, George Washington University School of Medicine, Washington, DC, USA

    H. Gil Rushton MD, FAAP

Authors
  1. Dana C. Rice MD
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  2. Massoud Majd MD, FACR
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  3. H. Gil Rushton MD, FAAP
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Corresponding author

Correspondence to H. Gil Rushton MD, FAAP .

Editor information

Editors and Affiliations

  1. Pediatric Urology Department, Cohen Children’s Medical Center of New York, Long Island, New York, USA

    Lane S. Palmer

  2. Pediatric and Adolescent Urology Institute, Cleveland, Ohio, USA

    Jeffrey S. Palmer

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Rice, D.C., Majd, M., Rushton, H.G. (2014). Renal Imaging: Infection. In: Palmer, L., Palmer, J. (eds) Pediatric and Adolescent Urologic Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8654-1_12

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