Summary
Definition
History and exam
Key diagnostic factors
- fever >102.2°F (39°C)
- 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 hematuria (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 maneuvers)
- constipation
- vesicoureteral reflux
- sexual activity
- no history of breast-feeding
- obstructive anomalies or previous surgery
- immunosuppression
Diagnostic investigations
1st investigations to order
- urine dipstick
- urine microscopy
- urine culture
- blood culture
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 urine reagent strip
Treatment algorithm
Contributors
Authors VIEW ALL
Interim Division Chief
Pediatric Nephrology
The Children's Hospital at Montefiore
Associate Professor of 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 topic. 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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