Managing urinary tract infections


Urinary tract infections (UTI) are common in childhood. Presence of pyuria and bacteriuria in an appropriately collected urine sample are diagnostic of UTI. The risk of UTI is increased with an underlying urological abnormality such as vesicoureteral reflux, constipation, and voiding dysfunction. Patients with acute pyelonephritis are at risk of renal scarring and subsequent complications such as hypertension, proteinuria with and without FSGS, pregnancy-related complications and even end-stage renal failure. The relevance and the sequence of the renal imaging following initial UTI, and the role of antimicrobial prophylaxis and surgical intervention are currently undergoing an intense debate. Prompt treatment of UTI and appropriate follow-up of those at increased risk of recurrence and/or renal scarring are important.

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Corresponding author

Correspondence to Tej K. Mattoo.

Additional information


1. b. Uretheral catheterization or suprapubic aspiration should be performed in infants and newborn

2. d. LE and nitrite

3. d. Can be a normal finding in children with neurogenic bladder

4. c. DMSA renal scan

Multiple-choice questions

Multiple-choice questions

(Answers appear following the reference list)

1. Which one of the following statements regarding UTI diagnosis is true?

  1. a.

    Clean-catch urine sample can be used in all children

  1. b.

    Uretheral catheterization or suprapubic aspiration should be performed in infants and newborn

  1. c.

    Uretheral catheterization has a lower likelihood of contamination compared with suprapubic aspiration

  1. d.

    Periuretheral adhesive bag can be used in boys but not girls because of contamination risk

  1. e.

    Any bacterial growth from a catheterized urine sample is considered significant

2. Of the following, which one is the most specific test for UTI by dipstick?

  1. a.

    LE alone

  1. b.

    Nitrite alone

  1. c.

    Protein and blood

  1. d.

    LE and nitrite

  1. e.

    Protein and LE

3. Which one of the following characterizes asymptomatic bacteriuria?

  1. a.

    Pyuria is present

  1. b.

    Most commonly caused by Pseudomonas Aeruginosa

  1. c.

    Antibiotic treatment is indicated

  1. d.

    Can be a normal finding in children with neurogenic bladder

  1. e.

    Increased risk of scarring if antibiotic prophylaxis is not used

4. Which of the following tests is the current gold standard for diagnosing renal scarring?

  1. a.

    Ultrasound examination

  1. b.

    Intravenous pyelography

  1. c.

    DMSA renal scan

  1. d.

    CT scan

  1. e.

    Radionuclear cystography (RNC)

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Saadeh, S.A., Mattoo, T.K. Managing urinary tract infections. Pediatr Nephrol 26, 1967–1976 (2011).

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  • Urinary tract infection
  • Vesicoureteric reflux
  • Management