Last reviewed: 28 Sep 2021
Last updated: 08 Oct 2021

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 (toddlers, older children, and adolescents)

Risk factors

  • age <1 year
  • female sex
  • white children
  • uncircumcised boys in the first year of life
  • previous UTI
  • bladder bowel dysfunction
  • vesicoureteral reflux
  • sexual activity
  • no history of breastfeeding
  • anatomical abnormalities or previous surgery to the urinary tract
  • immunosuppression
  • protein-energy malnutrition

Diagnostic investigations

1st investigations to order

  • urine dipstick
  • urine microscopy
  • urine culture

Investigations to consider

  • blood culture
  • full blood count
  • inflammatory markers
  • cerebrospinal fluid (CSF) analysis
  • fungus urine culture
  • serum creatinine, urea and electrolytes
  • renal ultrasound
  • dimercaptosuccinic acid (DMSA) scan
  • voiding cystourethrogram
  • CT scan abdomen (contrast-enhanced)
  • abdominal MRI (contrast-enhanced)

Treatment algorithm

Contributors

Authors

Joana Dos Santos, MD, MHSc, FRCPC

Assistant Professor of Pediatrics

Staff Medical Urologist

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

JDS declares that she has no competing interests.

Acknowledgements

Dr Joana Dos Santos would like to gratefully acknowledge Dr Beatrice Goilav, Dr Frederick Kaskel, Dr Mary Anne Jackson, and Dr Rene VanDeVoorde, previous contributors to this topic.

Disclosures

BG, FK, MAJ, and RV declare that they have no competing interests.

Peer reviewers

Martin Koyle, MD, MSc, FAAP, FACS, FRCS(Eng), FRCSC

Professor

Department of Surgery and Institute of Health Policy, Management and Evaluation

Staff Pediatric Urologist

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

MK declares that he has no competing interests.

Daniel T. Keefe, MD, FRCSC

Pediatric Urology Fellow

The Hospital for Sick Children

Toronto

Ontario

Canada

Disclosures

DTK declares that he has no competing interests.

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