Practice Rational Imaging

Investigating urinary tract infections in children

BMJ 2013; 346 doi: (Published 30 January 2013) Cite this as: BMJ 2013;346:e8654
  1. A Davis, radiology specialist trainee year 21,
  2. B Obi, consultant paediatrician2,
  3. M Ingram, consultant radiologist2
  1. 1St George’s Hospital NHS Trust, London SW17 0QT, UK
  2. 2Royal Surrey County Hospital, Guildford GU2 7XX, UK
  1. Correspondence to: A Davis adavis{at}
  • Accepted 13 November 2012

Urinary tract infection is common in childhood, and most children recover without complications. Use of imaging to check for abnormalities or complications therefore needs to be targeted carefully. This article summarises current guidance on clinically and cost effective use of imaging for urinary tract infection in childhood

Learning points

  • The role of imaging is to identify underlying abnormalities that may predispose to urinary tract infection (such as obstruction or vesicoureteric reflux) and possible complications from urinary tract infection (such as renal scarring)

  • Early imaging should be targeted towards patients most at risk of structural abnormalities or complications, including all children with recurrent urinary tract infection, those aged <3 years with atypical infection, and babies <6 months old with urinary tract infection

  • This subset includes all children with recurrent infection and children aged <3 years with atypical urinary tract infection

  • Consider further imaging for babies <6 months old who do not have atypical or recurrent infection but who have an abnormal ultrasound result

  • Micturating cystography is the gold standard test for detecting vesicoureteric reflux, as the dimercaptosuccinic acid (DMSA) scan is for detecting renal scarring, and each is indicated for specific subgroups

A 5 month old boy presented to his local accident and emergency department with irritability, fever, poor urine output, and foul smelling nappies when they were wet. His mother had had an uncomplicated pregnancy with no abnormalities detected on antenatal ultrasonography. On clinical examination the child looked unwell, with signs of sepsis, including a temperature of 39.8°C and raised C reactive protein and white cell count. A urinary tract infection was confirmed by clean catch mid-stream urine sample. His urine analysis was positive for blood and leucocytes, and Klebsiella was grown in the culture sample. His urine infection was considered atypical because of his septicaemia and infection with a non-Escherichia …

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