Imaging strategy for South African children with their first proven UTI in a tertiary hospital setting

Urinary tract infection (UTI) is the most common invasive childhood bacterial infection. While it has a benign course in most children, there is a risk that some will develop renal scarring, hypertension and chronic renal failure. There are no simple clinical means to identify those at risk and who would benefit from treatment and so all children with first proven UTI are subjected to imaging. Imaging is directed at detecting vesico-ureteric reflux (VUR), obstruction from pelviureteric junction (PUJ) obstruction or posterior urethral valves (PUV) and kidneys that are scarred or at a risk for scarring. Unfortunately, no single imaging method is able to detect all of the above. Also, the advantages and limitations of many of the imaging methods are not clearly appreciated. This article presents the uses, advantages and disadvantages of current imaging methods and outlines a strategy that attempts to limit the radiation dose and invasiveness of the procedure.