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 UTIOutpatient ultrasound.
Atypical UTIInpatient ultrasound, outpatient DMSA scan and VCUG.
Recurrent UTIInpatient ultrasound, outpatient DMSA scan and VCUG.
Age 6 months–3 years
Uncomplicated first UTINo imaging.
Atypical UTIInpatient ultrasound, outpatient DMSA scan.
Recurrent UTIOutpatient ultrasound, outpatient DMSA scan.
Age >3 years
Uncomplicated first UTINo imaging.
Atypical UTIInpatient ultrasound.
Recurrent UTIOutpatient ultrasound, outpatient DMSA scan.
American Academy ofPediatrics(AAP)21
Age 0–24 months
Any febrile UTIUltrasound.
Complex or atypical circumstancesVCUG.
Recurrent UTIFurther evaluation.
Canadian Paediatric Society(CPS)35
Any febrile UTI aged <2 yearsUltrasound.
European Association of Urology/European Society for Paediatric Urology23
Any febrile UTIUltrasound.
Suspicion of VUR and/or pyelonephritisVCUG and/or DMSA scan.
Spanish Association of Paediatrics36
UTI that requires admission, is recurrent or with suspected complicationsInpatient ultrasound.
First UTI if aged <6 monthsOutpatient ultrasound.
Recurrent or atypical UTIOutpatient 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-Escherichiacoli 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.