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Controversies in the radiological investigation of paediatric urinary tract infection

Deptartment of Radiology, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 ILF, UK

• Parenchymal damage dictates the fate of the kidney and subsequent morbidity.
  
• Early antibiotic treatment prevents renal damage.
  
• Most infections are due to E. coli from an ascending infection.
  
• Micturating cystourethrography (MCU) alone is a poor detector of reflux and should now be replaced selectively by direct radionuclide cystography (DRC) ± MCU, which in combination identify more cases of reflux than a single examination.
  
• Voiding dysfunction should receive at least as much attention as reflux.
  
• Ultrasound should be studied further to increase its sensitivity for reflux in order to decrease the need for procedures using radiation.
  
• In future MRI may become the most informative imaging modality for the investigation of the urinary tract.
  
• ⁹⁹Tc^m dimercaptosuccinic acid (DMSA) renal scintigraphy in the context of acute infection is sensitive but of unknown value.
  

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