Investigation of urinary tract infection in children

Urinary tract infections are a common and sometimes troublesome problem for children, which in a minority may be associated with significant renal tract pathology and renal damage, yet there is little consensus amongst experts as to how they should be investigated. Correct diagnosis of UTI and prompt treatment of symptomatic infection are far more important than the subsequent investigation strategy. An investigation strategy should limit the use of invasive investigations involving ionizing radiation, to those where the information obtained is necessary to guide treatment. Children at high risk of pyelonephritic scarring or major underlying urinary tract anomalies should be identified and screened to identify renal scarring and urological disorders that require prompt treatment. These children are likely to be very young or have severe (pyelonephritis/septicaemia) or recurrent infection or positive findings on medical history and examination. Seemingly healthy, older children, with a negative medical history and physical examination who have a solitary minor or asymptomatic infection, which responded to treatment, do not require investigation as they are far less likely to have significant underlying disorders and the few who do so will be identified when they re-present with further infection.