Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever >39°C (102.2°F)
  • irritability (neonates and infants)
  • poor feeding (neonates and infants)
  • suprapubic tenderness
  • costovertebral angle tenderness

Other diagnostic factors

  • foul-smelling urine (infants, older children, and adolescents)
  • dysuria (preschool age, older children, and adolescents)
  • urinary frequency (older children and adolescents)
  • abdominal/flank pain (infants, older children, and adolescents)
  • vomiting
  • ill appearance (neonates)
  • gross haematuria (older children and adolescents)
  • new-onset urinary incontinence (infants, older children, and adolescents)

Risk factors

  • age <1 year
  • female sex
  • white children
  • uncircumcised boys in the first year of life
  • previous UTI
  • voiding dysfunction (frequency, urgency, withholding manoeuvres)
  • constipation
  • vesicoureteral reflux
  • sexual activity
  • no hx of breastfeeding
  • obstructive anomalies or previous surgery
  • immunosuppression

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine microscopy
  • urine culture
  • blood culture
Full details

Investigations to consider

  • fungus urine culture
  • renal ultrasound
  • dimercaptosuccinic acid (DMSA) scan
  • voiding cystourethrogram
  • renal scintigraphy
  • CT scan abdomen (contrast-enhanced)
  • abdominal MRI (contrast-enhanced)
  • circulating cathodic antigen (CCA) urine reagent strip
Full details

Emerging tests

  • enhanced urinalysis
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Attending Physician

Pediatric Nephrology

The Children's Hospital at Montefiore

Associate Professor of Clinical Pediatrics

Albert Einstein College of Medicine

Bronx

NY

Disclosures

BG declares that she has no competing interests.

Dr Beatrice Goilav would like to gratefully acknowledge Dr Frederick Kaskel, Dr Mary Anne Jackson, and Dr Rene VanDeVoorde, previous contributors to this monograph. FK, MAJ, and RV declare that they have no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Pediatrics and Family Medicine

Department of Pediatrics

Hasbro Children's Hospital

Providence

RI

Disclosures

RR declares that he has no competing interests.

Professor of Family Medicine and Chairman of the Department of Family Medicine

University of Texas Health Sciences Center

Tyler

TX

Disclosures

RV declares that he has no competing interests.

Associate Professor

Pediatric Nephrology

Cincinnati Children's Hospital Medical Center

Cincinnati

OH

Disclosures

EJ declares that she has no competing interests.

Staff Specialist Paediatrician

Children’s Hospital at Westmead

Westmead

Australia

Disclosures

Not disclosed.

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