Table 3.

Published guidelines for imaging following a first febrile urinary tract infection

Guideline	Ultrasound	VCUG	Late DMSA
NICE 2007 [139]	<6/12 Yes >6/12 atypical UTI	No unless abnormal US or atypical UTI	Atypical UTI
AAP 2011 [7]	Yes	No unless abnormal US	No
ISPN 2012 [140]	Yes	No unless abnormal US or risk factors	Abnormal US and/or VUR
CARI 2014 [141]	No unless absent antenatal US, atypical UTI, mass, poor stream, slow response	No unless recurrent febrile UTIs or US suggestive of posterior urethral valve	No unless reduced kidney function
Canadian 2014 [142]	Yes	No unless abnormal US suggestive of obstruction or high grade VUR
EAU-ESPU 2015 [143]a	Yes	Yes consider after second febrile UTI in boys >1 year with option of a “top down” approach performing DMSA instead and VCUG if positive	No DMSA if VCUG positive or VCUG if DMSA positive
Urology Section AAP 2012 [74]b	Yes	Yes	No

^aThe EUA-ESPU guidelines were updated in 2021 (https://doi.org/10.1016/j.jpurol.2021.01.037), restricting a VCUG to those with an abnormal ultrasound or atypical UTI. The EUA-ESPU guidelines remain referenced in the article as these were the guidelines quoted by authors in the publications reviewed

^bThe Urology Section of the AAP published a dissenting view on the updated AAP guidelines regarding the investigation and management of a first febrile UTI, concerned that lack of a VCUG placed children with unrecognized VUR at risk of pyelonephritis and scarring

AAP American Academy of Pediatrics, CARI Caring for Australian and New Zealanders with Kidney Impairment, EAU-ESPU European Association of Urology – European Society of Pediatric Urology, DMSA ^99mTc-dimercaptosuccinic acid scan, ISPN Italian Society of Pediatric Nephrology, NICE National Institute for Health and Care Excellence, US ultrasound, UTI urinary tract infection, VCUG voiding cystourethrogram