pediatric UTI

All children age <24 months with a febrile UTI should undergo renal and bladder ultrasound to evaluate for hydronephrosis and ureteral dilation, which may suggest an underlying anatomic abnormality. Ultrasound should be performed after the acute illness has been treated as renal inflammation during infection can lead to false-positive results.

Patients with an abnormal ultrasound or recurrent, febrile UTIs should undergo a voiding cystourethrogram (VCUG) in addition to renal ultrasound. VCUG can identify vesicoureteral reflux, which often requires treatment with prophylactic antibiotics. Neither VCUG nor prophylactic antibiotics are indicated for a patient with a single uncomplicated UTI.

Children age >2 with an isolated UTI do not require imaging if treatment results in clinical resolution of symptoms. This infant has a higher risk of genitourinary tract abnormalities than an older child and should undergo renal and bladder ultrasound.