Early descriptions of childhood urinary tract infection (UTI) focused on findings at postmortem examination or children referred to hospital because of chronic or recurrent infection often persisting for months or years.¹ Many of these children had gross vesicoureteric reflux (VUR), chronic pyelonephritis, and sometimes other serious underlying anomalies such as neurogenic bladder.² Further investigation revealed proteinuria, hypertension, anaemia, complicated pregnancies, and impaired renal function. Long term follow up studies have supported this impression, and in a significant proportion of children and adults, end stage renal failure is thought to be due to chronic pyelonephritis.³ Such cases were often collected over many years and brought together for the purpose of describing the constellation of symptoms to other health professionals, with a view to identifying diseases and syndromes and starting to understand their causes and prevention. These early studies were not generally epidemiological studies but highly selected groups who showed the most severe or persistent symptoms.

The natural history of UTIs probably started to change in the 1950s with the advent of antibiotics and development of paediatric services. The radiological anomalies associated with recurrent UTIs, particularly vesicoureteric reflux and renal scarring, were described by Hodson and Edwards.⁴ The high rate of detection of vesicoureteric reflux and renal scarring in children investigated following UTI prompted a call for routine imaging tests in all children following UTI in …