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Nov 2011

Reduced Imaging After Urinary Tract Infection: Are Benefits Accompanied by Adverse Risks?

Author Affiliations

Author Affiliations: Department of Pediatrics, Princess Margaret Hospital for Children, Perth, Australia (Dr Hewitt); and Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy (Dr Montini).

Arch Pediatr Adolesc Med. 2011;165(11):1047-1048. doi:10.1001/archpediatrics.2011.173

Febrile urinary tract infections (UTIs) are among the most common serious bacterial illnesses in infants and young children. Urinary tract infection has a reported prevalence of 14% in febrile infants younger than 8 weeks1 and 5% in children with unexplained fever younger than 2 years.2 The introduction of antibiotics allowed treatment of these infections, and improved imaging modalities have resulted in detection and evaluation of a wide range of kidney and urinary tract disorders. What is less certain is the relationship between febrile UTIs and chronic kidney disease. Much of the renal damage previously thought to be the consequence of UTI has been shown by improved antenatal ultrasonography to be congenital renal hypodysplasia.3,4 The influence that various imaging techniques and treatment strategies have on long-term outcomes remains unclear, keeping in mind that vesicoureteral reflux (VUR) is a significant risk factor for scarring,5 the severity of scarring correlating with the severity of reflux.6