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Introduction
Clinical presentation
Clin. aproach to ivestig. and menag. of UTI
Cortical scintigraphy in urinary tract infection
Cystigraphy in urinary tract infection
Vesicourethral reflux (VUR)
The grading systems for vesicourethral eflux
Detection of vesicourethral reflux
Micturating cystourethrography (MCUG)
Radionucleotide cystography (RNC)
Direct radionuclide cystography (DRC)
Indirect radionuclide cystography (IRC)
Dynamic renal scintigraphy in UTI
Practical problems in pediatric nucl.med.
Preparation
Dose schedule
Injection
Imobilisation/ sedation
Conclusion

1. INTRODUCTION

In terms of future morbidity and mortality, one of the most important considerations inurinary tract infection (UTI) is the age of patient. In adults, only those with complications orillnesses that fail to respond to treatment require investigation to exclude underlying pathology. Incontrast, the young are at a risk of future hypertensive and renal disease; imaging techniques are therefore of paramount importance to identify those with renal parenchimal disease at an early stageand permit appropriate and adequate treatment [1]. Scintigraphic evaluation of urinary tractinfection, pyelonephritis, and renal scarring represents a significant portion of a clinical paediatricnuclear medicine practice [2]. However, children are not just a small adults and careful attention todetail and patient care is even more important than with adults [3].

Urinary tract infection (UTI) is a common problem in the paediatric population. Stork proposed a series of definitions in an effort to standardize the diagnosis of UTI. A simple uncomplicated urinary tract infection is defined as an infection confined to the lower urinary tract (bladder, urethra, and ureters). Upper urinary tract infection (pyelonephritis) is infection of renal parenchyma. Asymptomatic bacteriuria is bacterial growth in urine unassociated with clinical symptoms. Significant bacteriuria depends on the method of collection. For a midstream clean-catch specimen, significant bacteriuria requires more than 100,000 colonies/ml, whereas any growth from a suprapubic aspirate is considered significant. The word asymptomatic, however, may be misleading. When questioned after the positive urine culture was obtained, 66% to 76% admitted urinary symptoms, leading Salvage et al to suggest the term covert bacteriuria rather than asymptomatic bacteriuria. The cumulative risk of symptomatic urinary tract infection from birth to 11 years of age has been estimated at 3.0% for girl.s and 1.1 % for boys.

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