Ecografia renale dopo il primo episodio di infezione delle vie urinarie: risultati di una revisione sistematica e metanalisi

Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis The clinical utility of renal ultrasound after the first febrile urinary tract infection (UTI) is much debated, and guideline (LG) recommendations often differ. The objective of this study was to determine the prevalence of urinary tract abnormalities detected by ultrasound after the first febrile UTI in children. Medical research databases were used to search for articles on studies on the use of ultrasound in children with first UTI. Primary outcome was the prevalence of urinary tract abnormalities and clinically important abnormalities detected on renal ultrasound. Twenty-nine studies were included, with a total of 9.170 children studied. Of the 27 studies that reported the sex of participants, the average percentage of males was 60% (range, 11% -80%). The prevalence of abnormalities detected on renal ultrasound was about 22%, while the prevalence of clinically important abnormalities was about 4%. The most detected abnormalities were hydronephrosis, pyelectasis, and ureter dilatation. Urinary tract obstruction was identified in 0.4% of cases, and surgery was performed in 1.4% of cases. No studies reported parent-reported outcomes. The results suggest that 1 in 4-5 children with first febrile UTI have a urinary tract abnormality detected on renal ultrasound and 1 in 32 an abnormality that changes their clinical management. Given the considerable heterogeneity of the studies and the lack of comprehensive outcome measurement, the authors suggest the need for well-designed prospective longitudinal studies to fully evaluate the clinical utility of renal ultrasound after the first febrile UTI.