FEBRILE URINARY TRACT INFECTIONS

Key words: Febrile urinary tract infection (UTI), Diagnosis, Treatment, Follow-up

We present the recommendations, prepared by a working group of the Italian Society of Pediatric Nephrology, for the diagnosis, treatment, imaging protocol and use of antibiotic prophylaxis in children having their first febrile urinary tract infection (UTI) between 2 months and 3 years of age. We also review the evidence from the literature on the long term medical consequences of post-infectious scars, as the aggressiveness of the diagnostic protocol depends on the severity of the consequences and the possibility to prevent them. Studies show very heterogeneous results regarding the population studied, the diagnostic criteria used for the diagnosis of UTI and the evaluation of outcomes (hypertension, renal damage). It appears that cohorts were selected on the basis of the presence of high grade reflux or dysplastic kidneys and a relation between UTI and general morbidities appears ambiguous and not measurable. Diagnosis of febrile UTIs is based on the clinical suspicion and appropriate urine sample collection (mid-stream urine or catheterization). An exclusive oral treatment is a reasonable option to treat a first febrile UTI. Antibiotic prophylaxis is not recommended in children with vesico- ureteric reflux grade I-II to prevent further UTIs; for severe refluxes (grade III to V), no definite evidence is available. We propose to perform a renal ultrasound in all children and an aggressive imaging protocol (micturating cystogram and renal DMSA scan) only in a group of high risk children selected on the basis of anamnestic, clinical and echographic data.