The guidelines for investigation into first-time UTIs in young children keep on changing, based on best evidence, and the whole area continues to be controversial. What we do know is that recurrent UTIs can lead to scarring, which may cause renal failure as an adult.

It hasn’t been proven that reflux leads to infection, or that prophylaxis with low-dose antibiotics prevents recurrent infection. It’s therefore unclear who to investigate and what to do with the results. If a baby has an uncomplicated UTI (no evidence of pyelonephritis) after the age of 3 months, he/she is unlikely to need any tests. If the child has had a UTI requiring admission — implying a kidney infection — a DSMA scan would be helpful to look for scarring. If he or she has had recurrent infections, the standard continues to be ultrasound and VCUG, with the DMSA scan giving more useful information on damage to the kidneys. Unfortunately, we still find some scarred kidneys in children with who have normal VCUGs with little evidence of prior infections. Meanwhile there are others with high-grade reflux who never have kidney problems.

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