• ultrasound
• urinary tract infection
• vesicoureteral reflux
• voiding cystourethrogram

Despite the frequency of urinary tract infection (UTI) in childhood,¹ and the numerous contributions on the subject in the literature, there is surprisingly little consensus on urinary tract imaging requirements, perhaps reflecting the paucity of high quality intervention studies and data on long term outcome.

Diagnostic imaging following UTI in childhood has been accepted practice for nearly 40 years since the original studies² showed a high prevalence of abnormalities, and specifically a link between renal scarring and vesicoureteric reflux (VUR). Inherent in this strategy was the assumption that identification of these abnormalities would influence outcome. In the intervening decades, much has been learned about additional risk factors for post-infection renal scarring, such as obstructive uropathy, recurrent febrile UTI, particularly in the infant and young child, diagnostic delay, inadequate treatment, dysfunctional voiding, the host inflammatory reaction, as well as factors specific to the infecting bacterium.³

In addition, clear gender specific differences in renal scarring have been established, with global parenchymal loss occurring more often in boys with dilated VUR, and focal scarring in the absence of VUR being seen more often in girls, particularly after recurrent febrile UTI. …