Table 3.
Summary of imaging recommendations from selected international guidelines for young children with UTI
| Recommended imaging test(s) | |
| National Institute for Health and Clinical Excellence (NICE) UK16 | |
| Age 0–6 months | |
| Uncomplicated first UTI | Outpatient ultrasound. |
| Atypical UTI | Inpatient ultrasound, outpatient DMSA scan and VCUG. |
| Recurrent UTI | Inpatient ultrasound, outpatient DMSA scan and VCUG. |
| Age 6 months–3 years | |
| Uncomplicated first UTI | No imaging. |
| Atypical UTI | Inpatient ultrasound, outpatient DMSA scan. |
| Recurrent UTI | Outpatient ultrasound, outpatient DMSA scan. |
| Age >3 years | |
| Uncomplicated first UTI | No imaging. |
| Atypical UTI | Inpatient ultrasound. |
| Recurrent UTI | Outpatient ultrasound, outpatient DMSA scan. |
| American Academy of Pediatrics (AAP)21 | |
| Age 0–24 months | |
| Any febrile UTI | Ultrasound. |
| Complex or atypical circumstances | VCUG. |
| Recurrent UTI | Further evaluation. |
| Canadian Paediatric Society (CPS)35 | |
| Any febrile UTI aged <2 years | Ultrasound. |
| European Association of Urology/European Society for Paediatric Urology23 | |
| Any febrile UTI | Ultrasound. |
| Suspicion of VUR and/or pyelonephritis | VCUG and/or DMSA scan. |
| Spanish Association of Paediatrics36 | |
| UTI that requires admission, is recurrent or with suspected complications | Inpatient ultrasound. |
| First UTI if aged <6 months | Outpatient ultrasound. |
| Recurrent or atypical UTI | Outpatient ultrasound, and VCUG or contrast enhanced bladder ultrasound especially if aged <6 months, and DMSA scan especially if aged <3 years. |
Uncomplicated UTI: responds well to appropriate treatment within 48 hours.
Atypical UTI: includes very unwell/sepsis, abnormal urine flow or renal function, non-Escherichia coli uropathogen.
Recurrent UTI: ≥3 episodes of cystitis or ≥2 episodes of UTI including at least one episode of pyelonephritis.
Inpatient ultrasound: during acute infection.
Outpatient ultrasound: within 6 weeks.
Outpatient DMSA scan: 4–6 months following UTI to differentiate acute infection from scarring.
NICE, CPS and AAP guidelines suggest consider VCUG if abnormal ultrasound, for example, dilation suggesting severe VUR, obstruction and scarring.
DMSA, dimercaptosuccinic acid; UTI, urinary tract infection; VCUG, voiding cystourethrogram; VUR, vesicoureteric reflux.