Eur J Pediatr Surg 2011; 21(5): 283-286
DOI: 10.1055/s-0031-1277212
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Experience with the NICE Guidelines for Imaging Studies in Children with First Pyelonephritis

R. Lytzen1 , J. Thorup2 , D. Cortes3
  • 1Department of Pediatrics, Hvidovre Hospital, Section of Endocrinology, Hvidovre, Denmark
  • 2Rigshospitalet, 4272 Paediatric Surgery, Copenhagen, Denmark
  • 3The University of Copenhagen, The Department of Pediatrics, Hvidovre Hospital, Hvidovre, Denmark
Further Information

Publication History

received April 02, 2011

accepted after revision April 07, 2011

Publication Date:
15 June 2011 (online)


Purpose: This retrospective study evaluates the applicability of a selective approach for imaging in children aged 0–15 years with a first episode of pyelonephritis, based on the UTI guidelines of the National Institute for Health and Clinical Excellence (NICE).

Material and methods: A total of 96 consecutive patients were included (age range: 0.1–14.9 years, median age: 0.7 years), treated for a first episode of confirmed culture-positive pyelonephritis. At initial hospitalization all patients underwent ultrasound examination of the kidneys and urinary tract (US) and technetium-99m mercaptoacetyltriglycine scinti- and renography (99mTc MAG3). If vesicoureteral reflux (VUR) was suspected, then prophylactic antimicrobial therapy was prescribed and the patients were referred to a surgeon for further evaluation including voiding cystoureterography (VCU). Patients with known urological anomalies including antenatally diagnosed anomalies were excluded. All patients were followed up for a median of 5.2 years (3.5–8.6 years).

Results: Initially, US findings were abnormal in 29 (30%) patients and 99mTc MAG3 findings were abnormal in 20 (21%) cases. At follow-up, prophylactic antimicrobial therapy was prescribed for 19 (20%), and VUR was diagnosed by VCU in 9 patients. Surgery was carried out in 7 (7%) patients, primarily for VUR. If the NICE guidelines had been initially followed, 5 of our 9 patients with VUR would not have been identified. VUR surgery was performed in 4 of these cases. Moreover, 9 cases with urological anomalies subsequently prescribed prophylactic antimicrobial therapy would have been missed.

Conclusion: We do not recommend following the imaging strategies of the NICE guidelines for children with a first episode of pyelonephritis. Our most important argument is that at follow-up, after a minimum of 3.5 years, the initial diagnosis of VUR would have been missed in 4 out of the 5 patients who underwent VUR surgery.



Dr. Jørgen Thorup


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