There is no consensus on the most cost-effective approach to the diagnosis of acute pyelonephritis
(APN) and on the best therapeutic approach to vesicoureteral reflux (VUR). Not
enough attention is payed to the diagnosis of urinary tract infection, while there is an excess
of diagnostic procedures to confirm APN and to search for VUR. Available evidence
shows that fever and abnormal urine analysis are sufficient to make the diagnosis of APN.
Ultrasonography can further restrict the indications to cystourethrogram. A conservative
approach to VUR is effective in the great majority of cases.