Febrile urinary tract infections in children Are invasive diagnostics always necessary?

Urinary tract infections (UTI) in childhood are a serious illness concerning acute morbidity, inpatient hospital treatment and-ultimately-their association with end-stage renal disease. The indication for further, more invasive diagnostics should be subjected to a critical review. Congenital anomalies of the urinary system in combination with febrile urinary infections are a relevant risk factor for the development of renal disease. In addition to patient history and clinical examination, the primary diagnosis of a urinary tract infection includes appropriate urine and laboratory examination and a urologic sonography. Further investigation is indicated in the presence of anatomical abnormalities or after a confirmed, clinically relevant febrile urinary tract infection. Further diagnostic workup primarily includes voiding cystourethrography and/or a dimercaptosuccinic acid (DMSA) scan. After assessment of relevant vesicoureteral reflux and/or renal parenchyma damage, the decision of further surgical treatment can be made to prevent further UTIs and renal disease.