Paracetamol (acetaminophen) is available as an over the counter medicine and is very frequently administer at home to children for a range of indications including fever and pain. The MHRA (Medicines and Healthcare products Regulatory Agency) has released new dosing advice to ensure maximum efficacy and safety.
A 12 week old boy is admitted with a fever and being generally unwell. He is found to have a urinary tract infection. He is treated with antibiotics and several weeks after the infection resolves he has a number of investigations performed:
Radiological investigation 1.
Radiological investigation 2.
Q1. What kind of investiagtion is radiological investigation 1 and what does is show?
Q2. What kind of investiagtion is radiological investigation 2 and what does is show?
Micturating cystourethrogram (MCUG). This shows vesicoureteric reflux on the right side with right sided hydoureter and hydronephrosis.
A nuclear medicine investiagtion called a DMSA (dimercaptosuccinic acid) renal scan. It shows that the right kidney is small and scarred with lesions at the upper pole and low/mid lateral territory.
Children under the age of 5 years with a UTI frequently have follow-up radiological investigations (see Prodigy Knowledge for further information). In this case the first scan is a MCUG scan where the bladder is catheterised and then filled with contrast medium. In this case it shows abnormal retrograde flow of fluid from the bladder back into the right ureter and kidney (called vesicoureteric reflux). The right sided ureter and collecting system/kidney are distended. Vesicoureteric reflux (VUR) predisposes to UTIs.
VUR is also associated with a type of renal damage called reflux nephropathy. In this case the second scan, which involves the injection of a radiolabelled compound called DMSA, shows that the right kidney is small and scarred. This is likely to be secondary to the VUR and infection.
