ABSTRACT
The urinary tract is a relatively common site of infection in infants and young children. Urinary tract infections (UTIs) are more common in girls except during the first few months of life. Up to 1.5% of boys and 5% of girls develop UTIs during the school years. UTIs are important because they can cause acute morbidity and may result in long-term medical problems, including hypertension and reduced renal function. Management of children with UTI involves repeated patient visits, use of antibiotics and exposure to radiological investigations. Vesicoureteral reflux is the most commonly associated abnormality, and reflux nephropathy is an important cause of end-stage renal disease in children and adolescents. However, when reflux is recognized early and managed appropriately, renal insufficiency is rare. Some children who present with an apparently uncomplicated first urinary tract infection turn out to have significant reflux. Subclinical infections can sometimes lead to severe bilateral renal scarring. Therefore, even a single documented urinary tract infection in a child must be taken seriously. Accurate diagnosis is therefore extremely important for two reasons: to permit identification, treatment and evaluation of the children who are at risk for kidney damage and to avoid unnecessary treatment and evaluation of children who are not at risk, for whom interventions are potentially harmful and provide no benefit.
