The investigation and follow-up of urinary tract infection

Abstract

Summary (Table 2) The aims of investigation are to diagnose unequivocally the first infection a child develops, particularly in infancy, and to identify risk factors predisposing to renal damage. This means all children require renal imaging and younger children MCUG. Decisions on the intensity of investigation and follow up are based on risk estimation. Follow up is aimed at negating the effects of identified risk factors, such as VUR, by careful medical or surgical management. Once renal scarring has occurred lifelong follow up for hypertension and possible functional deterioration is mandatory. 1.Allages (a)Renal USS — obstruction, abnormal morphology, size discrepancy, ? scars (b)AXR — small stones, spine defects (c)DMSA Scan — definitive diagnosis of scarring, differential function (d)Isotope Renogram — evaluation of upper tract obstruction, differential function 2.Variable with ageMCUG — for reflux, bladder size, emptying, urethral valves (i)All infants (ii)possibly all pre-school children certainly if renal scars, FH of VUR, clinical upper tract infection, neurogenic bladder suspected, recurrent episodes of UTI (iii)After age 4 years if renal scarring and recurrent UTI